A nasal cannula is a simple, flexible device designed to deliver supplemental oxygen to people requiring respiratory support. It consists of a lightweight tube that splits into two prongs intended to rest just inside the nostrils, ensuring the body receives enough oxygen. When confused, patients often pull out the tubing, immediately interrupting therapy and creating a danger of low blood oxygen levels, known as hypoxia. Maintaining continuous, safe oxygen delivery for a confused individual requires physical securing methods, environmental adjustments, and constant monitoring.
Physical Strategies for Securing the Cannula
Physically anchoring the nasal cannula tubing helps prevent inadvertent removal, but safety must remain the foremost concern. Specialized securement devices, often featuring a hydrocolloid adhesive base, offer a strong yet gentle bond to the skin. This material minimizes skin irritation and allows the device to remain in place for 24 to 36 hours before needing a change.
If specialized devices are unavailable, medical tapes like Hy-Tape (“pink tape”) are effective because their zinc oxide-based adhesive is gentle on sensitive skin. A technique involves placing a small hydrocolloid dressing on the upper cheek as a protective base, then securing the tubing to it with paper or clear film tape. The soft tubing slide, which cinches the cannula under the chin, must be used to ensure a snug fit that does not restrict circulation or cause undue pressure.
The tubing must be routed carefully, typically looping over the ears and securing to the cheek or neck. Never wrap the tubing tightly around the neck due to the risk of strangulation. For patients who pull at facial tubing, guide the lines over the head and secure them behind the neck or near the shoulder blade to keep them out of the visual field. Always use a quick-release mechanism or ensure tape can be removed rapidly in an emergency.
Behavioral and Environmental Management
Non-physical strategies focus on reducing the patient’s impulse to pull the cannula by managing the environment and their mental state. Simple distraction techniques redirect focus away from the tubing. Examples include playing familiar, soothing music or engaging them in a simple, repetitive task.
Reducing unnecessary sensory input is effective in managing agitation and confusion, which often trigger tube pulling. This involves maintaining a calm, quiet room and using low, indirect lighting. Ensure the patient’s eyeglasses or hearing aids are in place to correct sensory deficits. Providing a calendar or a large clock, along with frequent verbal reminders of the time and location, helps reorient the patient and reduce anxiety.
The patient’s comfort should be checked regularly, as pain, hunger, or needing to use the restroom can quickly trigger agitation. Positioning the patient so the tubing is less visible can also reduce the visual cue that prompts grabbing. For example, secure the tubing down the back of the neck and cover it with a shirt or blanket.
Monitoring Skin Integrity and Preventing Injury
Securing the cannula introduces a risk of skin breakdown that must be actively managed. Pressure injuries commonly occur on the delicate skin behind the ears, the cheeks where tape is applied, and the inner rim of the nostrils. These injuries result when the cannula tubing or securing devices exert continuous pressure on a bony prominence.
Caregivers should perform a detailed skin check at least twice daily, looking for signs of breakdown such as persistent redness, blistering, or open sores. Before applying any adhesive, use a protective skin barrier wipe or a thin hydrocolloid dressing as a base layer on the cheeks to shield the skin from the tape. The nostrils should be gently cleaned with soap and water and kept moist with a water-based lubricant. Avoid petroleum-based products, which can degrade the cannula plastic or risk lipoid pneumonia if inhaled.
Recognizing When Professional Intervention is Needed
The removal of the nasal cannula places the patient at risk for hypoxemia, which is a medical emergency. Caregivers must be able to recognize signs that the patient is not receiving enough oxygen or that their underlying condition is worsening. Significant physiological warning signs that the body is struggling for oxygen include a resting pulse rate over 100 beats per minute or a respiratory rate exceeding 20 breaths per minute in a resting adult.
If a pulse oximeter is available, an oxygen saturation reading of 92% or below is considered a medical emergency requiring immediate intervention. Other alarming physical signs of severe hypoxemia include a bluish tint to the lips, nail beds, or skin, which is a late sign. The patient may also be using accessory muscles in the neck and chest to breathe.
A sudden, acute change in mental status also warrants an immediate call for emergency medical services. This includes a rapid increase in confusion, new hallucinations, extreme restlessness, or an inability to rouse the patient. These changes may indicate delirium caused by low oxygen or a serious underlying medical event.