question about scope of practice and the use of high flow O2

Specialties Geriatric

Published

I was wondering why nurses aren't allowed to give high flow O2 without a doctors order (at least in CA). The reason I ask is that I am currently working as an EMT (until I start nursing school) and I regularly respond to calls at SNFs where a patient is in respiratory distress and the nurse only has them on a cannula a 2-3 liters (and the machine only goes up to 5). I've heard this is because they need a doctors order to put them on high flow. Is there something I don't know about O2? Thanks.

Specializes in Education, Acute, Med/Surg, Tele, etc.

YOu can go 6 per nc, but I find it isn't effective...stick with 4...need more get better equipment is my motto...and for me that is 9-11 LOL!!!!!

Yep, you are so right about hypoxic drive in EMT/PARAMEDICS, and I count on it! Since I can't bump up O2 (mainly because I have nasal cannulas), I trust them to get those O's going...and they do! Bump it up..we can fix the rare hypoxic drive if we must...is my hubbys moto (paramedic).

But the old legality scares that run nursing have nurses having to check with a doc all the friggen time putting patients at risk of hypoxia anyway! OH well...that is when my EMT/PARAMEDIC friends come in..they come quicker than getting through a receptionist, nurse, and maybe the doc on the phone...especially on weekends or Lord forbid it happens between 1200 and 1300! LOL!

I am more with the paramedics, always have been...nursing protocols hold me back much of the time...O2 is a perfect example.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

I have heard you can do the ol NRB at 8...but why...bump it up to 12 is totally cool with me! But then again...that is the paramedic wannabe in me, and what my hubby would say. I have seen people put on 6 with NRB...again I always say WHAT?

Guess it depends on protocols per county. Heck...I have one, don't you dare move that guage unless you have an MD order..it is a med you know (duh! Like I haven't heard that one before..LOL!).

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I have heard you can do the ol NRB at 8...but why...bump it up to 12 is totally cool with me! But then again...that is the paramedic wannabe in me, and what my hubby would say. I have seen people put on 6 with NRB...again I always say WHAT?

Guess it depends on protocols per county. Heck...I have one, don't you dare move that guage unless you have an MD order..it is a med you know (duh! Like I haven't heard that one before..LOL!).

Check out the manufacturer's website. The masks do not work with less than 10-12 LPM. These are the most wrongly used type of masks in LTC because nurses haven't been educated about the use of different masks and their requirements.

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Specializes in Critical Care/ICU.

Here's the dope on the dope (02) when we use it with a non-ventilated patient:

Low Flow:

Nasal Cannula.

MD orders are for 1-6 liters

-bubble humidifier is used

-rarely do we go more than 5 liters except when a patient is first extubated and only for a very short time then.

High Flow:

Non rebreather mask

MD order will read 100% 02

Flowmeter is set to 15 lpm

-even though the order is for 100% 02 the most this system is actually capable of delivering is 60-70% Fi02, we rarely use these.

Venti-mask (aka Venturi mask)

MD order is stated in % 02

Flowmeter is set flush to the top (full blast!).

Delivers 24-50% Fi02 depending on the adapter used on the flowmeter.

-% 02 is set on peice on tubing attached directly to the mask.

-very accurate in % of 02 delivered, if 40% is ordered, that's what the patient gets.

-ususally dry system, not good for patient with secretions that will become dry without humidification

-I hate these things, we rarely use them.

High Flow 02 mask (or trach collar or face tent) - aka Pegasus?

MD order is stated in %02

Flowmeter is set flush to the top (full blast!).

Delivers 35-90% Fi02 depending which set-up is used (either 35-60% or 60-90%)

-accurate in Fi02 delivery like the venti (except for the face tent and trach collar)

-% Fi02 is set on water container below flowmeter.

-humidified

-these we DO use

I think that's it.

The only thing we don't need an order for is the bubble humidifier with the nc. Our orders usually read "02 via nc 0-6 liters for 02 sats >94%." Or just simply "02 to maintain 02 sats > or equal to 94%," then we use whatever suits the situation. But of course it's the ICU and we never hesitate to do what we have to do, even bag a patient while waiting for anesthesia to arrive to intubate.

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