Oxygen, Suction & Respiratory Care

Oxygen Delivery Devices

PCTs assist with and monitor supplemental oxygen delivered through several device types, each with a distinct flow-rate range and approximate oxygen concentration delivered:

A nasal cannula run above about 4 L/min tends to dry and irritate the nasal mucosa, so humidification is often added at higher flows. A non-rebreather mask must be run at a high enough flow, typically 10 to 15 L/min, to keep the reservoir bag from collapsing when the patient inhales. A collapsed reservoir bag means the patient is rebreathing their own exhaled carbon dioxide, which defeats the purpose of the mask, so the bag should stay at least two-thirds full at all times during use.

Oxygen Fire Safety

Oxygen itself does not burn, but it dramatically accelerates combustion, so any area using supplemental oxygen requires strict precautions:

• No smoking, candles, or open flame anywhere near an oxygen source.
• Keep oxygen tanks and tubing away from electrical equipment that could spark, and away from heat sources.
• Avoid oil-, petroleum-, or alcohol-based products, including some lotions and lip balms, near the oxygen delivery device, since these become flammable in an oxygen-enriched environment.
• Store and secure oxygen cylinders in an upright position so they cannot fall and damage the valve.
• Post oxygen-in-use signage at the room entrance per facility policy.

Oral and Yankauer Suctioning

Oral suctioning removes secretions, vomitus, or blood from a patient's mouth and upper throat when the patient cannot clear it independently, most often using a rigid Yankauer suction catheter. Key safety points: use standard precautions, including gloves and a mask or eye protection if splashing is likely; suction only the mouth and the area the PCT can directly visualize, since oral suctioning is a shallow, visible-area procedure and not deep tracheal suctioning; apply suction only while withdrawing the catheter, never while inserting it; and limit each suction pass to a brief period to avoid depleting the patient's oxygen supply or irritating the tissue. Reposition the patient's head to the side when possible to reduce aspiration risk during and after suctioning.

Pulse Oximetry

A pulse oximeter is a noninvasive sensor, typically clipped on a fingertip, that estimates the percentage of oxygen-saturated hemoglobin in the blood, called SpO2, along with the pulse rate. A normal SpO2 reading for a healthy adult is generally 95 to 100 percent; a reading persistently below about 90 percent is considered low and should be reported immediately. Factors that can produce a falsely low or unreadable pulse ox signal include cold extremities, poor perfusion, nail polish, and patient movement, so the PCT should recheck the sensor placement and warm the extremity before assuming a low reading reflects the patient's true status. However, any genuinely low or rapidly dropping reading should always be reported to the nurse without delay.

TCDB and Incentive Spirometry

TCDB, which stands for Turn, Cough, and Deep Breathe, is a routine respiratory care measure, especially important for postoperative or immobile patients, to help prevent pneumonia and atelectasis, or collapsed alveoli. The patient is repositioned, guided through several deep breaths, and encouraged to cough to clear secretions, typically every 1 to 2 hours while awake.

Incentive spirometry uses a handheld device to encourage a slow, deep, sustained inhalation, which helps re-expand the lungs and prevent postoperative respiratory complications. Correct technique: the patient sits upright, seals the lips around the mouthpiece, inhales slowly and deeply to raise the indicator or piston as high as possible, holds the breath for about 3 to 5 seconds at the top of the inhalation, then exhales normally and rests before repeating, typically 10 breaths per hour while awake. The PCT should encourage and remind patients to use the device as ordered and report if a patient is unable to reach or maintain their target volume.

Scope Limits and Documentation

A PCT never adjusts an oxygen flow rate, switches a delivery device, or discontinues oxygen therapy without a specific order from a nurse or physician, even if the patient requests a change or appears more comfortable at a different setting; flow-rate changes are a clinical decision based on the patient's oxygenation status. What the PCT does control is accurate observation and documentation: recording the device in use, the flow rate in liters per minute, the pulse oximetry reading, respiratory rate, and any signs of respiratory distress such as labored breathing, use of accessory muscles, or a bluish tint to the lips or nail beds (cyanosis). Documentation should also note tolerance of suctioning or incentive spirometry, including how many uses were completed and whether the patient met the target volume. Because respiratory status can change quickly, any new shortness of breath, a falling SpO2 trend even if still above 90 percent, or a patient pulling at their oxygen device should be reported promptly rather than simply logged for the next round of vital signs.