How many liters of O2 can a patient with COPD be on - page 2
I recall being told by an instructor during my nursing clinicals that a patient can be on up to 4L of O2 but no more due to the retention of CO2 and loss of respiratory drive if they have COPD. A... Read More
Oct 27, '07Geesh, I am an RT in, and I can't WAIT for that crap to come up. I have coded a poor dude thanks to the nurse who thought she couldn't crank up that O2. She followed "what she'd heard" and killed the guy. Nurses: Remember Maslow!!!!
Oct 27, '07I'm new a newbie and I'm doing a new grad program in the ED, and we VERY frequently get these people by ambulance.... struggling to breathe, sweating, sats in the 80s on room are, pale, & exhausted.
I too though that I couldnt crank up the 02, and a patient of mine recently was on 3L nc by the RT. Their sats were dropping to the mid 80's from lower 90's, so silly me decided to try a facemask to perhaps move more of the oxygen in front of the man's mouth, where he was doing more of his breathing....
I was promptly corrected by the Respiratory therapist. She politely informed me that I had performed a big No-no, and that in her opinion, facemasks shouldn't exist, period.
She got a Venti mask, and explained to me how to titrate this man's 02 very carefully, but ended up using 6L to do so with said mask.
Considering I was in the ED, it was ok to risk the person needing to be tubed if it meant that his Sats stayed up where they needed to be.... in that environment, it seems as if there is more of a focus on maintaining oxygenation than respiratory drive, because that can be handled if necessary.
It IS very individualized... the safest thing to do is watch what the RT does, confirm with the doc, and if the person begins to go downhill, carefully raise the 02 and get the rapid response team if you're on the floor.. better to call them and not need them, than to wait and find yourself with an unconscious patient.
and if you're in the ED, grab a doc and figure out a gameplan!
Oct 27, '07Quote from jbtampaGeesh, I am an RT in, and I can't WAIT for that crap to come up. I have coded a poor dude thanks to the nurse who thought she couldn't crank up that O2. She followed "what she'd heard" and killed the guy. Nurses: Remember Maslow!!!!
It's a bit scarey that there are some nurses that don't know to oxygenate a patient in distress. To me that's common sense 101.
I think what this instructor might be talking about is in general, maintenance, non-emergent o2 should be at the lowest tolerable dose. I've seen nurses and new grads pump up o2 "because their sat was 90% on 2L", not knowing that many COPDers tolerate low sats very well. I've seen CO2's rise in non-critical patients to past 100 from too much oxygen and the nurse scratch their head "why is he so lethargic?".
From all ends it sounds like we could use some good respiratory education.
My rule of thumb is I don't raise past the ordered o2 with consulting RT first, and then the MD.
Oct 27, '07Generally speaking, if I have a COPDer who's a/o X 3, they can tell me what their "home" sat is. I've had people who satted so low they were literally blue from cyanosis, and guess what, that was normal for them.
One patient was on a newfangled blower type gadget that brought her sats up to the 90's, but was able to come off of it right to where the home O2 with NC was set at 3 Liters.
It is pretty individualized, but I feel comfortable in a hospital setting to turn up the juice on anyone in respiratory distress. Respiratory distress looks way different than a CO2 retainer getting too much O2.
Oct 27, '07ABCs, no?
What's the good in saving their CO2 retention respiratory drive .... if they're dead? :uhoh21:
Oct 27, '07This is a very interesting thread. We've had some issues at our hospital lately about this. Thanks for all the imput!
Oct 27, '07Quote from leslymillI find your postings on this subject very didactic and not based on current practice. Nursing isn't set in stone and by the time you take consulting with others, cranking the O2 up by 0.5 lpm, your patient could be dead. I find this practice very frighteningI don't know what your clinical instructor was saying when she said," UP to 4 L/m." The standare is 2 L/M per n/c and I would not go over that without ABGs and a doctors order. If the clinical picture makes you want to go over, I would consult with co-workers because it would shock me to see a COPD on more than 2 L/M, unless you were testing and monitoring them closely and the doctor was being made aware.
Don't take my word for this alone. Though I have 22 years of clinical experience, I have been out for 4 years.
Oct 27, '07as with anything in Nursing / healthcare / medicien it depends o nthe patient
there are COPD patients who when hypoxaemic and short of breath you can give as much O2 as you want to as they don't retain, there are others who going over a fixed pefromance Fio2 of 0.24 will start to make them retain
if a patient with COPD and /or type 2 respiratroy failure is still hypoxic / hypoxaemic on standard thereapy they need to be carefully reviewed and evaluated and if necessary move to HDU area for close monitoring and regular ABGs ( and if they are going to need really regular ABGS for a art line with a sample port)
Oct 27, '07If I am ever hypoxic and you are my nurse ... unless we all agree that it's probably my day to die ... please, please ...
Oct 27, '07Quote from leslymillCan you picture yourself in that bed? Struggling to breathe while your nurse doles out the O2 in increments that are a drop in the ocean?Pulse ox 70% and tachypenic, I would call RT. ( I think a lot of COPD pts have wonderful relationships with RT even over nurses)
If they are cyanotic I would increment the O2 up and not leave his bedside while I waited for RT. You don't up O2 to 6L/M on a COPD pt like you do a chest pain or shock, you go from 2 to 2.5 to 3L/M.
Does thinking about it that way change the picture for you?
By all means call the RT stat. But are you really saying you'll be that stingy with the O2 in the meantime?
Wow. Just wow.
Oct 27, '07CPAP also does the trick at times in these cases.
I would bump up the O2 if I had to wait for a CPAP to come up, though. The first thing I would tell COPD'ers and their families would be to bring in their own CPAP at any rate.Last edit by BBFRN on Oct 27, '07
Oct 27, '07Quote from ginger58I find your postings on this subject very didactic and not based on current practice. Nursing isn't set in stone and by the time you take consulting with others, cranking the O2 up by 0.5 lpm, your patient could be dead. I find this practice very frightening
I find nurses who practice medicine without a license and arbitrarily bump up patients oxygen a bit frigthening as well. As I've said, I've seen outcomes when a patient is tolerating being 90% (which by definition is hypoxic) and the nurse cranks it up only to obtund then with a CO2 past 100.
Again, it's common sense that if a patient is actively in distress, or critically hypoxic, you oxygenate without dillydallying around.
Other than that the NP Act in Florida says an RN can only prescribe 2L. I think collorbation is very much the current standard of practice, at least it is with me.