I've spent the last few nights pondering this question ... let's use a "hypothetical" patient: Primip, induction (cytotec X2 then Pitocin), Pit is up to 6mu, FHR baseline 140-150bpm with average variability and accels up to 175, UC's q 3-6 minutes, 60-90 seconds long. Late decels are noted, first deep then more subtle (understanding that it is not resolving but that the baby is having more difficulty with the UC's). Patient is repositioned to left lateral, HOB flat and IV open. Mom shows 99% oxygen saturation on RA. FHR return to baseline with no further problems.
Would you put O2 at 8-10L via mask on this patient? Why? My first (new nurse) thought would be to apply oxygen but when I saw her O2 sat at 99%, I hesitated. Another RN came into the room and immediately applied the oxygen mask. After the day was over, I spent some time online searching for evidence proving that oxygen administration would have helped the mom and/or fetus. Interestingly enough, there was nothing that I could find that was definitive regarding supplemental oxygen when mom is already at 99% on RA.
What do you all think? I'd love some other input. Are we applying O2 as a habit without evaluating the moms current O2 saturation? Is it beneficial when she is already at 99%? Would love to hear what you all think about this!
Incidentally, went to the OR for a c/sec (hours after the lates resolved themselves), mom was tired of being in labor and doc was tired of listening to her ask for a c/sec. Bummer, too, since the patient was obese making her post-op recovery harder. No nuchal cord found, placenta looked great and baby labs all WNL.
Ah yes, forgot to mention that I also turned the pit off and provider was notified, as well (we'd been on the phone off and on for 20 minutes).
I do understand the theory behind putting 02 on the mom for the baby's benefit ... but still do not understand the science behind satting at 99% and additional need for oxygenation (for either mom and/or baby). If you have 99-100% of your total oxygen capacity, does more oxygen actually help? Maybe I'm just being dense here but I've never taken "that's the way we've always done it" as an answer. Anybody have a study or more info on this?
Edited to add: I'm going to research the Oxyhemoglobin Curve for more info .. I'm thinking that with a low H&H, less hemoglobin to carry O2 ... I'm not sure I'm even following myself at this point.
Last edit by SC RN on Jan 11, '06
Quote from BittyBabyGrower
It doesn't matter what the pulseox is reading...that probe is picking up the sat of the cells in that finger at that time. Sometimes, when you draw an ABG on someone that is sating 99, their O2 can be low. There is no way to know if that pulseox is totally correct without doing an ABG.
Right, we see this in the NICU all the time. We can have a patient who is saturating 100% but on the arterial blood gas, their oxygen level is low. If we increase their inhaled oxygen, they're still saturating 100% but on the blood gasses, we'll see an increase in the blood oxygen level.
I don't know how to explain it either. It's been awhile since I've studied pregnancy and fetal circulation! Maybe I should do some research?
Hmmmm...let me think here...
Okay, sometimes we'll have a newborn who we start on oxygen via a cannula or vent. We'll have them at 100% and then we'll get the blood gas and the oxygen level is through the roof. So we'll decrease the inhaled oxygen and eventually we'll see a decrease in the blood gas oxygen level as we go. The baby may be saturating 100% this whole time, but there is actual proof in the labs that the oxtra oxygen DID affect the baby when it was being given even though the sats didn't change.
ETA: I guess this would mean that even if the mom is saturating 99 or even 100%, applying oxygen will still increase the amount of oxygen in her blood and thus provide extra oxygen to the baby.
Last edit by Gompers on Jan 12, '06