Respiratory question for a patient with a trach...
- 1Dec 8, '12 by goannainI had a patient recently that was supposed to go for a procedure in the morning. He was getting O2 and the setup was 4L O2 with FiO2 at 28%. He had a trach so he was receiving O2 via a T-Piece and was connected to a nebulizer. The Dr. didn't want him to go for the procedure because "he was on 4L O2." But if the FiO2 was at 28%, was he really getting 4L O2?
If we were to compare this to a patient on nasal canula, what would it be equivalent to? Maybe 2L O2 nasal canula?
Thanks for your help.
- 1Dec 9, '12 by hlj123What was his reasoning for not transporting the patient "because he's on 4L O2" ?????
1) That is just the flow rate required to get the particular FIO2 (28%) the guy was on, no big deal.
2) Even if the guy was on a much higher FIO2 and/or flowrate, I still don't get what the issue is with transporting the pt to a procedure as long as he is stable?
- 2Dec 9, '12 by TraumaSurferLooks like someone did not get an inservice on the O2 equipment they are using.
The device used, which includes size and brand name, will determine the liter flow required to make 28%.
This is often a documentation error for many in nursing and for Paramedics. They will look at the liter flow and do not understand the entrainment or venturi system being used to acheive 28%.
To transport, you use a adaptable device which will give approximately 28%.
Also, if your unit does not have piped in air, the patient is on 28% because there is no option for just humidified air. Also, the patient might actually be on just humidied air and the FiO2 is set at 28% and 4 L to achieve a nice mist.
Know how each piece of equipment works and don't just memorize numbers. Every venturi type set up might have a different liter flow requirement regardless of the numbers. Never assume.
- 1Dec 9, '12 by woohIf he was on 28%, he was on 28%, and was NOT on 4L. This is a case where the liters mean nothing. The percentage is what counts.
Someone correct me on this, but the only time I can think of that you have both a flow rate AND percentage that both mean something, is high flow nasal cannula. But that's because the flow in that case is actually more of a pressure setting, like you'd have with BiPAP or CPAP.
When you have a venturi or HAM or trach collar, the O2 liter setting from the wall is just what the particular equipment requires to turn it into the percentage.
28% on a trach collar? I love to transport patients when they're that stable!
- 0Dec 10, '12 by goannainNo, I did not get an inservice on the equipment. We have RTs at our hospital and they manage all that stuff. It sucks, and I would like to know more about the equipment...but receiving training on RT equipment was just not available to us. Anyway, I also felt that the pt was stable enough to go too, but I work night shift. So I didn't have a say as to what happened in the day time and why the docs felt like he shouldn't go. My assignment got changed and I actually didn't get this patient back after I found out he didn't get to go for that reason. It was very frustrating!
- 1Dec 13, '12 by SugarcomaQuote from goannainHi goannain. This is probably my biggest pet peeve! I would like to say that I too received no education about our equipment because.....RT deals with that. This makes no sense to me! We nurses are ultimately responsible for that patient and their airway and even though I work with THE BEST RTS IN THE UNIVERSE! they are not standing at my patient's bedside all shift. Sometimes they are tied up with other patients and cannot be there when I may need them. What I did and what I would suggest that you do as well is establish a relationship with your RT's. Ask questions, ask questions, ask questions and volunteer to help them with things.No, I did not get an inservice on the equipment. We have RTs at our hospital and they manage all that stuff. It sucks, and I would like to know more about the equipment...but receiving training on RT equipment was just not available to us.
Grab a venti mask and make sure you know how to put it together, grab a non-rebreather and make sure you know how to set it up properly. (if you don't already know how) Make sure you know what brands of trachs your facility uses, when to change cannulas, dressings, etc. Volunteer to bag, instill, change ties, etc. while they are there and can supervise. This way you will know how to do things before you NEED to know how to do them. Review ABG's with them. Most are more than willing to share their knowledge and most really appreciate knowing they are valued by the nursing staff. I tease my RT's all the time and tell them they should wear capes because they are always swooping in to save the day! lol. I have learned so much from them and they are always more than willing to have me assume some mundane aspect of their job such as changing ties.
I honestly have no idea why this is not STANDARD education for every RN in every hospital on every unit! This is probably some of if not the most important equipment you will ever work with!