O2 saturation question

[kaseysmom, LPN]

My husbands grandfather was in the hospital today..and when the took his pulseox it was 95 - his breathing was labored- and noted as labored by the triage nurse, and upon listening to his lungs he was found to be congested. All throughout nursing school I have been told that a pulseox below 98 requires oxygen, all of my instructers, and even some nurses that I have dealt with in a clinical setting have ensured me that this is the case. Am I wrong?? Of course I am a nurse, however - I am willing to accept if I have been misinformed. Thanks =)

[Nightcrawler, BSN, RN]

Many, Many, Many older patients will have O2 sats well below 98. With some patients, for example those with COPD, the doctor will order that their sat be maintained between 89-92 with 92 being the absolute maximum because a saturation above 92 will shut off their hypoxic drive to breathe and they can go into respiratory arrest.

We were taught that in general the higher the O2 the better, but that 95 and above was no reason to worry, and that O2 isn't really indicated until around 92.

Remember though that as with anything assessment has to take precedence over the machines. The nurse always needs to look at the patient rather than relying on what the pulse ox says. What if the machine is calibrated incorrectly? And if he was SOB and congested, then it is reasonable to treat the presenting symptoms, and consult with the MD for O2 orders, or add 2L of oxygen if there is a standing order.

[Tweety, BSN, RN]

It depends on the patient and their history. Many chronically ill patients live with sats in the low 90s and upper 80s. In fact to qualify for home oxygen a steady o2 sat of 88% and lower is required.

Our 02 protocol that allows RNs to administer 02 up to 2L begins at 94% and below. So someone with an 02 of 97% without distress doesn't need oxygen.

That said, your grandfather was working real hard for that 02 sat and I would have administered oxygen based on that. If someone has a sat of 95% but has to work real hard to maintain it, some supplemental oxygen may help them from working so hard.

[Blackcat99]

I took a reading on a patient who was actively "dying'. It said it was 95%. She died 7 hours later.

[kaseysmom, LPN]

Thanks for the replies =) My concern regarding the o2 sat was more of the fact that he was having labored breathing and congestion, but the fact that I had always been told that 98 and below helped to back that up. The nurse ended up by admin. oxygen when he was put in a room.

[Nursebaby23]

Yeah, the increased sats were a compensatory mechanism by the labored breathing, but he probably couldn't have continued that way. My rule is 93-96% being normal because I work with the elderly population, with O2% of 90-92 if they have COPD or pneumonia. But also, some of my resident's have better sats than mine:chuckle .

[cjan]

On our med/surg floor, many of our elederly patients o2 sats run 90-98%. He may have benifited from rt treatment. also aspiration comes to mind. Is he swallowing properly? I don't think a sat of 95 is anything major. We can apply o2 with standing orders. Many elderly pts. can become o2 dependant quickly.

we would have everyone on o2 if 95 was the cut off. A rt eval would be best. They are the experts. hope he is doing well.

[schroeders_piano, RN]

I have never heard of applying oxygen to someone who has a pulse ox of 98%. My hospital's protocol doesn't call for O2 to be applied unless the patient's pulse ox drops below 90%. Back in the ICU we don't worry unless it drops below 88%. It's just amazing how different every hospital's protocols are.

[IowaKaren]

I have a question on this line also: If a Pt. is getting BRBC's, let's say 2 units and at the start the Pt. was satting at 96% (which in normal circumstances be okay), is it proper to apply O2 on the Pt. because of the diminished RBC's, even though the Pulse Ox reads WNL and the Pt. is not exhibiting any signs of distress? I was told by a couple of RN's at change of shift that I should have gotten an order for O2, but to my thinking, how could extra O2 help until there was adequate RBC's to accomidate it?

[IowaKaren]

Opps, I meant to type PRBC's, not BRBC's.

[kaseysmom, LPN]

He does have COPD but his baseline pulseox is 98. On the floor, they have him on 3 1/2 liters o2 which to me is strange because he does have COPD w/o any kind of heart problems that are making it impossible for the heart to supply the body with enough oxygenated blood. However, on 3 1/2 liters o2 he is having difficulty breathing with and without exertion. I guess it's just strange to me because I was always told in nursing school that COPD pts shouldnt have their o2 above 2 liters

[Hellllllo Nurse, BSN, RN]

I learned that COPD pts should never have their 02turned up > 6 lpm, but another nurse I know was taught 3 l.

Anyone know what the standard is?