Delivering oxygen via trach

[agehrels]

I work at a long term/skilled nursing facility where we have multiple patients that receive oxygen by a trach collar. I myself have not had much experience with trachs. Our facility does not have piped in oxygen so we use a single chamber oxygen concentrator that has the humidifier bottle attached. We have a patient coming to us with the FiO2 at 35%. We have and RT and she does not want to take the patient due to the liter flow stating 9L. I was always under the impression that no matter what the FiO2 % that the flow rate should be 8L-12L. Am I wrong is thinking this?

[Double-Helix, BSN, RN]

You're correct. A 9L flow on a trach collar is in no way equivalent to another delivery device. That's simply the amount of flow required to carry the oxygen through the tubing. It would be like having a long hose and only turning the spigot on to a trickle. Think you're ever going to generate enough flow to clean something that way? It's the same principle.

[agehrels]

Thank you! The RT had said that we could take a patient at that % but when whatever nurse at the hospital also documented the 9L she said no because the liter flow rate was too high and she thought they would be able to wean the patient down to 35% and a lower liter rate. It confused me a bit because I have been trained in the past and I remembered that the liter of O2 was just the force to produce that certain % of O2 through that system not necessary the amount of oxygen the patient actually received.

[chare]

…I was always under the impression that no matter what the FiO2 % that the flow rate should be 8L-12L. Am I wrong is thinking this?

All trach masks that I am familiar with are the venturi, or air entrainment type. If this is the type mask you are referring to, the flow rates required for a specific FiO2 are variable, depending upon device and manufacturer. A quick internet review revealed flow rates ranging from 4 to 15 liters/minute, providing an FiO2 of 0.25 – 0.5. As there is such a wide range, you should review the device packaging information to determine the flow rate to provide the desired FiO2.

I'm curious as to why your respiratory therapist doesn't want to take this patient, as 9 liters/0.35 FiO2 are not unusual parameters for a trach mask.

[agehrels]

I am not sure exactly why. I am the MDS nurse and we have to collaborate to see if the patient is a safe admit on the nursing side and respiratory side and that was just the reasoning she gave the case managers. We have 10L concentrators so I wasn't too sure either.