# How many liters of oxygen can you be on with a nasal cannula?

The typical flow rate for a nasal cannula is 1-6 liters per minute (LPM). This means a patient can receive 60-360 liters of oxygen per hour. Over a 24 hour period, the range is 1440-8640 liters per day. The maximum flow rate is generally 6 LPM, which equates to 8640 liters per day.

## Oxygen Delivery with a Nasal Cannula

A nasal cannula is a device used to deliver supplemental oxygen to a patient. It consists of a lightweight tube which splits into two prongs that sit in the nostrils. Oxygen flows through the tubing and into the nose at a prescribed rate set on the oxygen source.

Nasal cannulas are capable of delivering low-to-moderate concentrations of oxygen. The typical flow rate is 1-6 liters per minute (LPM). This flow rate can be precisely adjusted based on the oxygen needs of the patient.

Some key points about oxygen delivery with a nasal cannula:

• Flow rates are measured in liters per minute (LPM)
• Typical range is 1-6 LPM
• Higher flow rates deliver higher oxygen concentrations
• Flow rate is titrated to maintain target oxygen saturation levels
• Maximal flow rate is generally 6 LPM

The flow rate dictates how much oxygen is delivered to the patient. At 1 LPM, the patient receives 60 liters of oxygen per hour. At 6 LPM, the patient receives 360 liters per hour.

### Oxygen Delivery Per Day

Over a 24 hour period, the amount of oxygen delivered can be calculated:

• At 1 LPM: 60 liters x 24 hours = 1,440 liters per day
• At 6 LPM: 360 liters x 24 hours = 8,640 liters per day

So the range of oxygen delivery per day with a nasal cannula is approximately:

• 1,440 – 8,640 liters per day

The maximum is generally 8,640 liters per day at a flow rate of 6 LPM.

## Factors That Determine Oxygen Flow Rate

There are several key factors that help determine the appropriate oxygen flow rate through a nasal cannula:

### 1. Target Oxygen Saturation Range

The primary goal is to maintain a target oxygen saturation level, which is measured by pulse oximetry. The normal range is typically 94-100%. In chronic lung conditions, the target may be set at 90% or above. The flow rate is titrated to maintain the desired oxygen saturation.

### 2. Medical Condition

The underlying medical condition will influence the amount of oxygen needed. For example, COPD and other chronic lung diseases often require higher flow rates. Acute conditions like pneumonia may require temporary increases in oxygen delivery.

### 3. Activity Level

During exercise and exertion, the flow rate may need to be increased to match the higher oxygen demand. At rest, the flow rate may be reduced.

### 4. Altitude

At higher altitudes, the concentration of oxygen in the air is lower. This means flow rates need to be increased compared to sea level.

### 5. Body Size

Larger patients typically need higher flow rates. This accounts for their higher overall oxygen demands.

By continuously monitoring oxygen saturation and adjusting the LPM rate, the optimal oxygen delivery can be maintained.

## Maximum Oxygen Flow Rate with Nasal Cannula

Most medical oxygen systems and wall outlets have a flow capacity of 0-6 LPM when using a nasal cannula. This maximum of 6 LPM delivers the highest concentration of oxygen possible with this device.

Exceeding 6 LPM does not increase the fraction of inspired oxygen any further. The nasal passages essentially become saturated. Moreover, higher flow rates may cause drying, discomfort, and nose bleeds.

Some situations where the maximum flow rate may be required include:

• Severe hypoxemia not improving on lower rates
• During exercise and exertion
• As temporary “boost” therapy if oxygen levels acutely drop
• In higher altitude environments

There are some specialty high-flow nasal cannula systems that can deliver up to 10 LPM of oxygen. However, traditional nasal cannulas connected to wall oxygen supply are limited to 6 LPM maximum for safety and efficacy.

Flow rates above 6 LPM would necessitate switching to a higher-capacity oxygen delivery device such as a non-rebreather face mask.

## Checking For Accuracy

It’s important to periodically validate that the prescribed LPM rate on the oxygen source matches the LPM delivery to the patient. This helps ensure patient safety.

Some ways to check for accuracy include:

• Use a flowmeter attached to the tubing to verify flow rate
• Perform periodic maintenance and calibration checks on oxygen equipment
• Visually confirm flow rate on oxygen source flowmeter
• Change cannula tubing regularly as cracks can alter flow
• Monitor patient’s oxygenation status and increase rate if needed

Ensuring proper oxygen flow helps avoid potentially hazardous hypoxemia if a device malfunctions unnoticed.

## Risks of Excessive Oxygen Delivery

While oxygen is critical for patients in respiratory distress, excessive delivery does carry some risks:

### Oxygen Toxicity

At very high concentrations, oxygen can have toxic effects on the lungs. This risk mainly occurs with prolonged use of extremely high oxygen levels.

### Respiratory Depression

Excess oxygen may cause a temporary decrease in breathing drive. This is usually only a concern in patients with chronic CO2 retention issues.

### Absorption Atelectasis

The nitrogen in room air helps keep alveoli inflated. Replacing nitrogen with high concentrations of oxygen can cause alveolar collapse.

### Oxygen Fire Risk

High-flow oxygen greatly increases fire risk from cigarettes, sparks, electrical equipment, and other ignition sources. Fire precautions are essential.

To minimize adverse effects, the lowest flow rate needed to maintain adequate oxygenation should be utilized.

Some benefits of using nasal cannulas for oxygen delivery include:

• Can provide sufficient oxygen for moderate hypoxemia
• Lightweight and comfortable for prolonged use
• Flow rate can be adjusted easily based on need
• Allows for eating, drinking, and communication
• Lower risk of claustrophobia compared to masks
• Less drying to nasal passages than high-flow options
• Relatively low cost disposable devices

The adjustable flow and patient tolerance makes nasal cannulas an excellent choice for many situations requiring supplementary oxygen over hours or days.

## Limitations of Nasal Cannulas

Some drawbacks and limitations of nasal cannulas include:

• Unable to deliver oxygen concentrations above 40%
• Not suitable for severe hypoxemia
• Oxygen delivery affected by nasal congestion or anatomical defects
• Air entrainment can dilute oxygen concentration
• Titration to determine proper flow rate can be complex
• Drying of nasal passages at higher flow rates
• Dislodgement of cannula can occur accidentally

For low-to-moderate oxygen needs, nasal cannulas are an excellent option. For critical patients requiring high concentrations, a delivery device such as a non-rebreather mask would be preferable.

### 1. Are there risks from too much oxygen through a nasal cannula?

Yes, excessive oxygen delivery can potentially lead to oxygen toxicity, respiratory depression, atelectasis lung collapse, and increased fire hazard. The lowest flow rate to maintain appropriate oxygenation should always be utilized.

### 2. What are some signs my oxygen flow rate may need to be increased?

Persistent low oxygen saturation levels below the target range, increased shortness of breath compared to baseline, decreased exercise tolerance, impaired cognition, headaches, and elevated heart rate can indicate the oxygen flow rate may need to go up.

## Conclusion

Nasal cannulas can deliver a wide range of oxygen flow rates, typically 1-6 liters per minute. This provides approximately 1,440 – 8,640 liters of oxygen per day. Flow is titrated based on oxygen needs but does not usually exceed 6 LPM due to equipment limitations and safety concerns. Periodic monitoring and equipment checks help ensure proper oxygen delivery. While nasal cannulas have some limitations, they are an easy-to-use and effective method for providing supplemental oxygen to many patients with hypoxemia.