Oxygen saturation

  1. I work in the midwest in a 25-30 bed NICU. We have 6 MDs and therefore 6 ideas on just about everything - including the 'proper' SaO2 parameters. The most often seen ordered is 90-95%.
    Even tho this isn't terribly narrow we still have lots of audible alarms (in an already too noisy world) Our Nelcor monitors have a preset neonatal range of 80-95%.
    Your comments?
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  2. 20 Comments

  3. by   nurseiam
    Our parameters are 88-95% unless specific orders are written.
  4. by   dawngloves
    Depends. Our parameters for intubated preemies are between 85-90% But big old term babies are >95%.
  5. by   KRVRN
    Preemies are ordered either 88-96% or 90-95%. Term babies are usually >94%.
  6. by   Heather333
    Depends on the baby. I have seen 88-98, 90-95, 95-99. We had a gastroschisis baby that they wanted the sats between 95-98 to make sure the gut was getting adequate perfusion. They just don't want the kids on any kind of O2 sitting at 100%.
  7. by   Anaclaire
    In my experience, each baby is ordered their own set of O2 sat parameters according to their age and condition. Usually kept between 90-94% if on a vent or CPAP or oxyhood. Nasal cannula babies are generally 88-93% and room air babies have their alarms set to sound if less than 88%.

    We too have several neonatologists and they generally request alarms set at similar parameters, but there is always one or two who are different...

    All our babies receiving oxygen have a copy of their orders (preprinted with "fill in the blanks" type spots for the MDs to fill out.) taped to the ventillator or other equipment beside the bed. The original stays in their chart and the copy is hung on the ventillator or other oxygen equipment area. Any updates to the ventillator rate, oxygen paremeters, etc. are double checked daily by each shift nurse and the respiratory therapist assigned to that baby to be sure the most recent orders are taped to the vent/equipment. Having the orders hanging on the vents and all makes it a lot easier to check on someone else's baby if the alarms are going off and the nurse is working with another baby or on break or something like that.
  8. by   dawngloves
    While on the subject, do you guys have problems with people changing your o2 settings and not telling you??!! If I had a dime for each time a doc saw my baby's sats at 95% and got all in a twist and turned his o2 down I could retire! Never asking why his o2 is up to 40% (cause he bradyed and desated and I am weaning him down thank you) or even telling me so the kid is desating again because they put him on 21%!!! Grrr!!
  9. by   xcski
    We'd all be rich if that were the case.
  10. by   NICU_Nurse
    My problem is with the RT's, not the docs. We are a teaching hospital, and the doc's don't know anything. Err, TOUCH anything is what I meant. ;>) I have been yelled at more than once by this one particular RT who has a habit of screaming, 'You're going to blind him for life! Let me get you a spoon so you can just gouge his eyes out!!' everytime he finds the O2 even a DEGREE higher than when he left it thirty minutes ago. Sorry, sir, didn't mean to anger you...I tried to tell the baby to wait to stop breathing until you returned, but he just wouldn't listen!!! Double grrr.
  11. by   Heather333
    Originally posted by dawngloves
    While on the subject, do you guys have problems with people changing your o2 settings and not telling you??!! If I had a dime for each time a doc saw my baby's sats at 95% and got all in a twist and turned his o2 down I could retire! Never asking why his o2 is up to 40% (cause he bradyed and desated and I am weaning him down thank you) or even telling me so the kid is desating again because they put him on 21%!!! Grrr!!
    RT comes in all the time and does it if they see the O2 is up from the previous settings. They do this without asking.... I quickly tell them that this kid just had a brady, desat, whatever and I was slowly weaning. Now I make it a point to catch them if I can before they start turning dials. That should at least ask me what's going on......Grrr! My sentiments exactly

    Heather
  12. by   Mimi2RN
    You can usually change the parameters on the monitors-including Nelcor and HP. Just because the presets say that newborns can't possibly sat over 95%, or have respirations of less than 30-that's just the imagination of the manufacturers-we don't believe them. If you tab to the right place on the Nelcor, hold down the alarm silence button, you can set the monitor wherever you want, up or down. (it's hard to remember when you're at home). The HP monitors have two places to change-we wondered why the alarm didn't go off-that's because in one place it was still set at 80, and we thought we had changed it to 90% sat, or whatever was ordered.
  13. by   karenelizabeth
    When I first started here 8 years ago it was 85-95 for all babies then we had a reg who changed all our protocols and it became 92-96 on premies and 95-100 on term (this dose seem mean alot of our chronic lung babied seem to be better tempered)

    our limits hace recently changed again, its not cos of ROP but becauce over oxygenation now has links to chronic lung disease, now for premies its 88-95 and term plus 95-100. some times there are set differently if the gases show tcpo2/sats reading diferently and also for cardiac babies who we except far lower sats in.
  14. by   Teshiee
    It is a real pain. I stay in their room most of the time I just silenced them. If I have to leave or take a break I just put the alarm back on.

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