Talking All Things Cardiopulm
This podcast is designed to discuss heart and lung conditions, treatment interventions, research, current trends, expert opinions and patient experiences.The goal is to learn, inspire and bring Cardiopulm to the forefront of conversation.
Talking All Things Cardiopulm
Episode 82: Breaking Down Low Flow Oxygen Devices
Working with patients on oxygen can feel overwhelming with all the possible devices that can be utilized. Whether or not you are a clinician who helps in making those decisions or you are actively working with patients using these devices, it’s important to understand their range of use, the level of FiO2 available, pros and cons, as well as, special considerations for each device.
Join me today, as we break down the most common low-flow oxygen devices available so you can feel confident in your clinical practice.
In this Episode:
- Difference between low-flow and high-flow devices
- Devices: Nasal Cannula, Simple Face Mask, Partial Non-Rebreather, Non-Rebreather and Oxymask
- Pros & Cons of each device
- FiO2 and flow required for each
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Rachele Burriesci:The Jane team understands how precious your time is and recognizes that charting can often be the most time-consuming administrative task for practitioners. That's why they're here to help. To save you from having to start your chart notes from scratch. You can check out Jane's template library, which gives you access to templates that have been generously created and shared by health and wellness practitioners in the community. Once you have the templates you like, you can choose to customize it further with charting tools such as range scales, text fields, check boxes and much more, to see how Jane can help you spend more time doing what you love. Head to the show notes. Click that link to book a personalized demo and, if you're ready to get started, use the code CARDIOPULM1MO at the time of sign up for a one month grace period applied to your new account. Thanks again, jane. Hello, hello, welcome back. I hope everyone's having a good week.
Rachele Burriesci:The weather here is one's having a good week. The weather here is Midwest fall, and if you're not from the Midwest, that basically means you're going to hit every season. Throughout the entirety of the day. You start out in a jacket and maybe even a sweatshirt and you may progress to t-shirt and shorts T-shorts that's the combo word right there. And that's exactly what happened today. So we had our first frost Tuesday night, so it was mass panic to get the basil picked.
Rachele Burriesci:It's one of the herbs that just does not do well. It probably could have made it through this first little freeze. Well, it probably could have made it through this first little freeze, but once it stays in that low 30 range it's done for, and it was already starting to kind of go on the other side of use. So I have picked every bit of basil that I had left. I have a few jars waiting to dry out to kind of preserve for the winter. It's the first year I'm doing that and I have about two more batches of pesto that I'm going to make. And Nikki actually got me this airtight ball jar thing. It's awesome. So without you you know boiling or anything you can actually make a mason jar airtight. So it's holding up. It's been about a day and a half and the basil still looks nice and green. So hopefully it'll hold up and I'll be able to make two more batches of pesto. If it does not, it will turn into some dried spice as well.
Rachele Burriesci:And thegano. Now, oregano is one of those like beastly herbs. That thing made it through the entire winter last year and was the first thing to come back at the start of spring. I have never grown oregano before. I actually don't use it much in cooking, but I heard that it helps with pest control in the world of like squash bug and things like that, so I tried it. You know mixed reviews on if it helped or not, but it's like wild. So if you know anything about mint, mint is one of those herbs that can take off like a weed, so always plant it in a pot, otherwise you're going to have a mint farm. Put oregano on that list. That baby has been producing like crazy, so I finally decided to cut it back and the plan is to also dry it. So have a couple of those kind of last garden things to wrap up before winter comes.
Rachele Burriesci:And last life update, aka garden and DIY podcast. The paver patio is moving All right, so I think we're going to hit the deadline. I told Nikki about my deadline of the 23rd and she kind of had an internal panic, but I think we're on track. Panic, but I think we're on track. So we have gotten the whole area leveled, pitched to an eighth of an inch. Looks pretty good, it's compacted and we have our bracing forms in place, which took longer than I expected yesterday, but apparently everything does.
Rachele Burriesci:And then Nicki bought this geo cell thing which I thought was really going to be super simple pop it in, you know, stake them in, load up the rock. It proved to be a little bit more challenging, but it was also dark, so that kind of played a little bit role, a role in not completing it last night. But I messed with it this morning by myself and I think it's actually going to work just fine. It just needs to be fully pulled out, so it's like an accordion and then, once it's at the right shape, it's going to fit well and I think once we have that in, I'm going to load it with rock and it can hang for a little bit before the papers go down. So we're like two to three steps away of being complete and I am. I'm like pushing, I want. That's all I wanted to do today. I had to really focus and make sure I was doing the tasks that I had to for everything outside of the patio world and uh, which brings me to today's episode.
Rachele Burriesci:So I wanted to talk about oxygen devices and I hesitated a little bit last week when I was recording the podcast because there is such variability in FiO2 range for specific devices and I wanted to triple check myself before I, you know, gave information that may or may not hold up and exactly exactly why I had this like internal. Let me check myself. It came to fruition. So blanket statement the oxygen devices that you are using in the hospital setting and I'm going to mostly stick to the hospital setting because that's where you're going to have the most variability in devices and choice. If you're in home health, you typically have more of the oxygen concentrator. Your patient is likely on some sort of nasal cannula type device. You typically don't have as much variability. With that being said, patients with ILD and things like that might have a different setup, and we can talk about that another time, because patients who have these higher FiO2 requirements when they're home sometimes have to be a little bit what's the word? Inventive creative on how they bleed in a certain amount of oxygen, and so I do actually have questions about that and I'm actually curious if I can find someone who would be a great podcast guest to talk about that a little bit more specifically. So I'm going to stay away from home health today.
Rachele Burriesci:Going back to the devices, the variability exists based on the manufacturer. So for the most part, the ranges I'm going to give you today are pretty close. But what I do recommend as a blanket statement is when you're opening up a new package and if you're the person to open up the device, look at the package. And if you're the person to open up the device, look at the package. And also on the device itself, if it's a device that is one that you're going to titrate and that titration is going to give you a different FiO2, there's usually a tag on the tubing that tells you at what liter per minute will provide blank FiO2. So always check it. But this is going to be pretty close and I'll tell you where there's some discrepancy and I have, you know, multiple sources that are off just a little bit from each other and they're all reputable sources. So just kind of keep that in the back of your mind.
Rachele Burriesci:So, before we jump into types of devices, the one thing I wanted to bring back from last week, and if you haven't listened to last week's podcast, after this one, jump back and take a listen, because they all kind of intertwine. But essentially, when we are, first of all, we need to respect oxygen. Oxygen is a prescribed medication, so to speak. Right, it's a prescribed. No, I don't want to say it that way, thank you so. So, before we jump into types of devices, I just want to bring back some of the concepts from last week, and if you haven't listened to last week's podcast, after this one, jump back. You don't need to listen to that one first, but they all work together and intertwine, so these two are going to be very well related.
Rachele Burriesci:The one thing I want to say about utilizing oxygen just as a blanket statement is that oxygen is a drug and requires a prescription. You should oxygenate your patients to maintain at or above goal, but I also think that we need to be careful with how much oxygen we are utilizing and not over oxygenate, and the goal is not to reach hyperoxemia. The goal is to prevent and treat hypoxemia. So you want to make sure that you are respecting the device itself, respecting oxygen for what it is. It is an assistance, right, like you are assisting the patient to do more or maybe just to maintain appropriate oxygenation at rest. So I just wanted to kind of blanket statement that After last week I wanted to see if there were any updated criteria on utilization of oxygen, goal SPO2, things like that.
Rachele Burriesci:And I actually found an article from the American Association of Respiratory Care and it was a systematic review that was looking at I'm sorry, not a systematic review, it's a clinical practice guideline, looking at multiple RCTs and such, to create a guidance on oxygen. It was a great article and one of the things that they were really trying to determine, based on these questions that they were asking, was is there an optimal oxygen range? And what they sort of settled on is that, based on a number of different research studies, a number of different populations, a number of different ICU critical illness type research projects, people tend to do better when their SpO2 ranges between 94 and 98%, better when their SpO2 ranges between 94 and 98%. It's like right in that sweet spot and they tend to have better outcomes for morbidity, mortality, length of stay, things of that nature. And they consider that conservative oxygen therapy, meaning they're respecting the oxygen, they're going to give what is needed and not necessarily more right. More is not better, better is better. What they did find which was interesting was that people that were a bit more liberal with oxygen delivery and maybe had more hyperoxemia in the studies tend to do worse long term. They had a higher mortality rate, maybe increased length of stay, maybe worsened time in the ICU, increased ICU days as well. So I found that really interesting, and they just kept coming back to between 94 and 98%, with the exception of COPD, years with CO2 retention and patients with ARDS. So those were like the two outliers. With that being said, I just want to reiterate that it is so important to understand your patient's SpO2 goal and their diagnosis. That exists, whether it's a lung disease or someone who's post-MI or post-CABG or post-surgery. It's important to understand why the oxygen is being used and what the goal SpO2 is, because that will help you make decisions and that will also help your communication with the team.
Rachele Burriesci:So when we're looking at oxygen delivery systems, it's typically broken into low flow systems and high flow systems. What I want to do today is really talk about low flow systems and then I think I might do a part two for high flow, because if I did all of them. This would be a very long podcast and I want this to be short and actionable and have some key points. What I do think I'm going to do is create a quick little oxygen guide after doing both podcasts. So I'll let you know when that is up and out and I'll have that link available for you.
Rachele Burriesci:So when we're thinking about low flow systems, we're thinking about oxygen devices that have variability in the FiO2 that's being delivered, and the reason why there is variability is because the type of device that's being used typically is going to allow some level of room air to coincide with the oxygen device that's in place and the flow the low flow piece of it is less than the inspiratory demands of the person. So typically we're going up to as high as 15 liters per minute. That would be considered a low flow system. Some textbooks, some articles define low flow as less than 20 liters per minute. So somewhere in that range, typically, if you're using wall oxygen, the highest you can go is 15 liters. So these are mostly the devices that you're going to see and hear about. There are others this is not an exclusive list. Others this is not an exclusive list.
Rachele Burriesci:The first one and probably the most commonly used oxygen device is the nasal cannula. Now we are talking about the OG nasal cannula, the original nasal cannula. Typically clear in color, it has potential to deliver one to six liters of flow, which results in about 24 to 44% FiO2. Some people prefer to say 0.24 to 0.44 FiO2. So whether you're using a decimal or percent coincides the same. I think the technicality is to use the decimal, but you'll see percentages quite a bit and you'll see it used interchangeably. So just kind of want to throw that out there as well.
Rachele Burriesci:The way I teach students to memorize this one and this is honestly one of the oxygen devices that I have like burned in my memory, other ones I'll check the tag and just make sure, because if you're not using them every day you might, you know, miss your percent. You want to make sure that you're accurate with how many liters you're delivering to how much FiO2 you think you're getting. Now, again, it is variable. So even though I'm telling you, with one to six liters you're going to get 24 to 44% FiO2, guesstimate estimate, variable based on your person, based on their tidal volume, based on how their breathing mechanics there's a number of different things that can alter that percent.
Rachele Burriesci:An easy way to remember nasal cannula, room air, ambient air that we're breathing, normal air, is 21% FiO2. When you're using a nasal cannula you typically add 4% to every liter, with the exception of the first one. So room air is 21%. 1 liter is 24%, 2 liters is 28%, 3 liters is 32%, 4 liters is 36%, 5 liters is 40%, 6 liters is 36%, 5 liters is 40%, 6 liters is 44%. So the max capability that a regular nasal cannula can provide is an FiO2 of 44% at 6 liters. Flow rate 6 liters per minute. Flow rate six liters per minute. If you jack that thing up past six liters you're not going to get more available FiO2. It pretty much caps out at six. Again, some variability.
Rachele Burriesci:There was one more thing I wanted to say. Oh, humidification, humidification. When you are providing flow through a nasal cannula, once you are greater than four liters per minute, they tend to add humidification for comfort for the patient, because it will cause irritation of the nasal passage. It can cause dryness, runny nose, bloody nose, that kind of thing. So the humidification really helps with comfort level.
Rachele Burriesci:Nasal cannula can have straight prongs or curved prongs. The curved prongs are more commonly seen because they're again more comfortable for the patient of where it's directing the airflow. The prong should be pointing down. It's one of the biggest things I see used incorrectly from the patient perspective. I have patients in the home health world or on virtual sometimes and I'll make them show me the prongs and many times they're actually upside down. So if the prongs are upside down it's basically just going to be shooting air up into the top of the nasal passage versus where it needs to go for turbulent airflow. So prongs down, humidification added. Once you're at four liters and above, you cap out at six.
Rachele Burriesci:Another thing from a infection control perspective there shouldn't be any sort of like Vaseline in the airways to help with comfort. That can actually trap germs and cause infection. And then the other thing is especially for your chronic oxygen use patients. They make cushions for the pressure point. So the cheeks tends to be a pressure point for the nasal cannula and the back of the ears. So having some options can be really helpful, especially if they're starting to get skin breakdown.
Rachele Burriesci:But nasal cannula is probably the most common device that you will see. It's used in the emergency department, in the ICU regular floors. Patients go home on it Very common. This is different than a high flow nasal cannula, and I'm going to talk about that next time. It has high flow nasal cannula has more range in general.
Rachele Burriesci:Next up in the low flow device is the simple face mask and it just fits over the nose and mouth. It's plastic in appearance. It has a oxygen tubing at the inferior aspect of the mask. There are two open ports in the mask and it can deliver a range between 35 and 55 percent. This one again has some variability depending what source you're reading. I've seen 35 to 50. I've seen 35 to 60. I'm going to stick with the 35 to 55 percent.
Rachele Burriesci:And that is utilizing a flow rate of 5 to 10 liters per minute, with the minimum being 5 liters. So it needs at least 5 liters of flow to essentially wash out the CO2 that is being exhaled, for patient safety, so to speak. So we always want to make sure that we have at least five liters of flow to prevent CO2 retention and rebreathing. They have the open ports that allows air room air to be getting in. So again, there's variability in what this FiO2 is and, depending on what you have, your flow rate on will translate to what the FiO2 is. So in theory, between 5 and 6 liters will give you about 35% FiO2. Between 6 and 7 liters gives you around 45% FiO2. And between 7 and 10 liters gives about 55% FiO2.
Rachele Burriesci:Again, pending your source, this has some variability in numbers, and I'm actually going to check myself, because the last source I just looked at was a touch different, and so I'll tell you what it is. So same device, right? Different source. We're at a simple face mask FiO2 40 to 60% at five to eight liters. So same thing, same concept. What I highly recommend is that when you get the device, check the tubing, see if it has a tag attached to it For something that has a different FiO2 per liters per minute. There should be some sort of instruction, so to speak, and each device might just be a little different based on its manufacturer. So always check it.
Rachele Burriesci:Simple face mask common to be seen. I actually feel like I'm seeing them less recently. I typically see a partial rebreather versus a non-rebreather more than a face mask. But it just really depends on your institution, right? As a mask, it's very difficult to speak. You can't eat or drink with it on, so every time you eat or drink, you're removing the mask.
Rachele Burriesci:So then you would need a different device, probably something in the nasal cannula department family, to kind of cover them. In between there's more contact with the face and so the better the fit, the more specific your FIO2 will be. But the better the fit, the more pressure you're going to have on your face, so they can be uncomfortable. In general they can cause skin breakdown on the face as well. The primary benefit kind of to do the flip side of it is that many patients tend to be mouth breathers, especially if they're dysmic. So it might be easier for them to get said FiO2 versus the nasal cannula, because you'll see that quite a bit Nasal cannula is in they're mouth breathing, and SpO2 is kind of teetering. So this is why education on breathing mechanics and pattern is just as important as what device is on the person. Right it's a and both it's not an or.
Rachele Burriesci:Okay, we're going to switch to partial rebreather mass. So partial rebreather mass looks pretty much the same on the face fit part. On the face fit part covers the nose and the mouth. The difference here is that there's typically one exhalation port that's open and there is a reservoir bag. So reservoir bag actually has some importance. The bag needs to be about a third to a half way full to be effective, because they're going to be breathing in some of that air as well. When the patient exhales, a third of their exhalation goes into the bag, so it's going to be mixed in that reservoir bag and then the rest of the two third goes out through the port. The port is also open. So with the partial rebreather you're breathing in some room air, some oxygen straight from the source and some of the reservoir bag that was part of your exhalation so has some mixed breathing again causes some variability. All pending tidal volume and all that good stuff.
Rachele Burriesci:Same concept as before is going to play a role in how tight that FiO2 is. So the partial rebreather can be anywhere between 40 and 70%. Another source that I have says 40 to 60%. So again super variable on what FiO2 range is available per device. If you have access to the device itself, always check the tubing, see if there's a sticker attached to it. Sometimes it gives you the exact liters to percent ratio, which is super helpful. If you have the bag, read the actual bag, because there is some changes between devices, and so I think it's just important to double check because your source might be different than that person's source, which is different from the next person's source, and check the device itself, it might actually give you the answer right up front. So partial rebreather has a little bit more range 40 to 60, 40 to 70%, fio2 at about 6 to 10 liters. Some say 5 to 10 liters. So again, a little variability.
Rachele Burriesci:This is another one that has to have a minimum flow to be sufficient and some say it needs to be at 10 liters to maintain the bag to be half or a third to half full. So same thing. There's a little variability in what resource you are checking. But this one can be comfortable for the patient. Patient breathes the air in. They're going to draw gas from the bag, from the oxygen source, from room air via the ports. When they exhale the first third goes into the bag, the two thirds goes out the ports. Um, have some range in there. Some sources will say at this many liters, you're at 40%. At this many liters, you're at 50%. At this many liters, you're at 60%. And some just say that you need to be at 10 liters to achieve this range.
Rachele Burriesci:So the partial rebreather, I feel like, has a lot of variability in the literature between textbooks and articles that kind of in the same family. They're close, but they're just different enough to be annoying, to teach right and also to have variability within practitioners. Same is true for a non-rebreather. So I have always learned that a non-rebreather is basically as close as you can get to 100%, which is true for a non-rebreather. So I've always learned that a non-rebreather is basically as close as you can get to 100%, which is true Theoretically. A non-rebreather, which is also a low flow device that's the one we're going to talk about next is capable again theoretically an FiO2 of 100% Everything that I have read, an FIO2 of 100% Everything that I have read going through residency, all that stuff. Really, 90% seems to be a happy number that people agree on, but more recently I've been seeing even lower 60 to 80% versus 60 to 90%. So there is still variability, and so one of the big things that causes the variability is the mask itself.
Rachele Burriesci:So the non-rebreather looks very similar to the partial rebreather. It's got the face mask and it has two ports that are, in theory, fully closed. It has the reservoir bag and it's got two one-way valves inside the device. So one of the one-way valves basically allows the oxygen source to deliver air in for inhalation but not anything out. Same is true for the reservoir bag. It allows for pulling air in from the reservoir bag because it's going to be filled up as well, but it doesn't allow exhalation into it, like the partial rebreather. So that's one big difference between the two. With that being said, the reason why you're not going to get closer to that 100% is those two ports aren't always fully closed, so sometimes it's just one port, similar to the partial rebreather again. And the rationale behind that is basically so the patient doesn't suffocate if the O2 source isn't pushing oxygen in, because if they have the mask on, the two ports are closed and it's all towards the patient.
Rachele Burriesci:If that device isn't providing oxygen, they're not pulling air in. So the two ports prevent room air from getting into the mask. But the ports have flaps so when they exhale, they can exhale their CO2. So there's no CO2 retaining in the non-rebreather, which is nice, right. In theory, you're getting true delivery of this oxygen source. If you take one of the ports off, in theory you're getting some room air in, which is not the intent but is a safety mechanism. So in theory, a non-rebreather is going to provide 60 to 80, 60 to 90 percent, pending the source you're looking at. Pending the source you're looking at at 10 to 15 liters per minute. And this device you have to be at least at 10 liters per minute to provide a partially full reservoir bag. So that has to happen. You have to prime the bag before being used. I'm going to just Shift my papers for a second See if I have any other notes On the non-rebreather yeah, flow of the oxygen needs to be Sufficient to maintain that bag A third of the halfway full. And the way that you do that Is by having it at least at 10 liters per minute in order to maintain that reservoir bag full.
Rachele Burriesci:And all of these devices, if I haven't said this already, is for the patient who is spontaneously breathing right. This is the person who is still actively breathing on their own and now needs support to maintain SpO2 at an appropriate goal. So what device are you using, right? We just went through four or five devices. Depends on your person. It depends on how far off of their goal. Are they right? Are they requiring? Have they maxed out their six liter nasal cannula? Well, now we need to start thinking about another higher level device that can cover, and there are some high flow devices that aren't higher level, like heated high flow nasal cannulas in the high flow device area. So there are still some other devices that we can help titrate with, help make the decision about. So I'm going to leave that one off the list until next week. But this is where you're starting to think well, what does this person need? Or if your person is really mouth breathing and that is the primary limitation for them to maintain SpO2 while they're doing exercise, well then maybe you need to find a face mask type device that can be more beneficial.
Rachele Burriesci:The last device I want to talk about is the OxyMask, and now, depending on where you are in the country, depends on what's in style, what's used. Quite a bit, I saw the OxyMask quite a bit in Michigan, specifically at the VA. I have not seen the OxyMask here in Kansas City, whether or not it just hasn't been, you know, choice for a patient or whatever, it just is not something that I'm seeing here. So I was going to leave it off, but I figure might as well throw it out there. So the OxyMask looks very similar. Well, it's a face-type mask but it has more holes in it, there's more access to room air and the OxyMask has changed since I've last used it in Michigan. There's an original OxyMask and then they have like two new updated versions that have a different titration on their FiO2 goal. But essentially the OxyMask is a face-tight mask that has more openings and so the patient tends to feel more comfortable in it. It's less claustrophobic, fitting in the reviews of said device.
Rachele Burriesci:The benefits of the OxyMask is comfort and you have a good range of FIO2 to utilize. So it goes from 24, the newer device goes up to allegedly 90%. When I was using the device it was lower than that. I think it was in the 65% range. So you had some variability, some range in FiO2 to use and that's going to go from one liter to 15 liters. So depending again on what the flow is depends on what FiO2 is being delivered. Again, there is variability pending room, air, patient's tidal volume, patient's effort, if they're dysmic, mouth breathing, nose breathing, all of those things. The OxyMask has a transducer that is placed right at the mouth level so it tends to have, again based on the manufacturer, a more direct FiO2 that can be breathed in.
Rachele Burriesci:The one thing I always had an issue with the OxyMask, because I use the OxyMask quite a bit in pulmonary rehab and even cardiac rehab. It was just a more comfortable fit. It gave a lot of range. The patients felt good exercising in it. The range FiO2 per flow is pretty extreme. So I'm just going to read this list to you.
Rachele Burriesci:And this is one of the updated OxyMask ranges. So at one liter flow they're going to get a 24 to 27% FiO2. That's fine, that's pretty tight, right, it's about 3%. At two liters flow, you're at 27 to 32%. Still good with that one. Okay, we got you know, 5% maneuvering in there. Good.
Rachele Burriesci:At three liters, you're at an FiO2 of 30 to 60%. Now I'm like, wait a second, that's a big range. That's a 30% variability. So are they getting 30% or are they getting 60%? My issue with that is if they're at the 60% side of things and they tip over, the choice of mask that's left to help keep this person above goal starts to get a little bit more tenuous. This is when you need a non-rebreather in your back pocket.
Rachele Burriesci:The newer OxyMas have more range, but I am still not happy about the amount of variability in FiO2. So I'm going to keep going. So at three liters, 30 to 60%. At four liters, you're getting between 33 and 65%. At five liters, you're getting between 33% and 65%. At 5 liters, you're between 36% and 69%. So I have a problem with that. Like middle chunk right, like between 3 and 5 liters, you're getting between 30% and 69%. At 7 liters, you're at 48% to 80%, and again now on the newer one, you're getting more range. At 10 liters, you're at a FiO2 of 53 to 85%. At 12 liters, 57 to 89%, and at 15 liters and above, you're between 60 and 90%. I love that the range of FiO2 has increased.
Rachele Burriesci:I have a really hard time with the range per flow leader Because, for instance, at 15 liters, you get between 60 and 90%. That's two different scenarios. 60% FiO2 versus 90% FiO2 is potentially, whether we're holding or we're like, okay to go. That's just a lot of range that I don't really love. And so when we talk about high flow systems next time, the Venturi mask has a more precise FiO2 delivery, which I have always liked, because you know what you're getting.
Rachele Burriesci:And even though I'm saying you know what you're getting, there's still variability there. So take it with a grain of salt, right. This is why you have to assess your patient. You have to assess their Sp. Your patient, you have to assess their SpO2. You have to be monitoring their tolerance level because the device is only as good as the device and it has a lot of variability depending on how your patient is presenting. So if your patient is more dyspick or they have, you know, a shallow breathing pattern or they're mouth breathing, it can highly affect the delivery of FiO2 that they're getting right. So there is a tremendous guesstimate aspect to the low flow systems. So I just want to put that out there, excuse me. Okay, so hopefully that was helpful.
Rachele Burriesci:There are a ton of devices. This only touches the surface, but these are the most common devices that you're going to see on a day-to-day basis, especially if you're in the acute care setting and maybe even in a SNF setting is anywhere between less than 20 liters per minute or less than 15 liters per minute in flow, which then gives you variable FiO2. Next week we're going to talk more about high flow systems and how that delivery system is a little bit different. Again, some of them are still lower level type masks, but some of them are much higher level and we'll just kind of touch the surface on some of those too. So hopefully this was helpful.
Rachele Burriesci:I will create an oxygen device cheat sheet to have a quick and dirty Again. Remember there is a lot of variability in FiO2 range pending the source that you're looking at, pending the manufacturer of said device, even if it's two non-rebreathers, right. So always check the device that you're using, always assess it before utilizing so you know your range and when you are working with a patient, that is on the top end of a device. The question that you should always have in the back of your mind is what's my backup device, just in case? All right, hopefully that was helpful. Drop me any questions in the DMs. If you have any questions for me, please reach out. I hope you all have a wonderful day and whatever you have to do, get after it.
