How many liters of O2 can a patient with COPD be on - page 2
by ChristopherH 100,935 Views | 62 Comments
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 colleague of mine today told me... Read More
- 0Oct 27, '07 by Emmanuel GoldsteinQuote from PageRespiratory!Exactly. I've seen them placed on a NRB over a cannula...'course by that point, it's pretty much an exercise in futility.Not every COPD'er is chronically hypercapnic. And not every retainer has burnt out thier central chemo recepters either. There is no magic number. If the Pt. is severly hypoxic, they need O's period, paragraph. God I love CRNA's. (And SRNA's too!) Also, to paraphrase Egans Fundamentals of Respiratory Care: "That oxygen therapy can cause some patients to hypoventilate should NEVER stop the RT (or other practitioner) from giving oxygen to a patient in need. Preventing hypoxia is the first priority".
On an assignment last year, walked in to find my patient fast on his way to arrest. RR ~ 2-4. The new RT had just given him a treatment, and thinking he "looked a little short of breath", cranked his O2 up to 6L. (she responded with the RRT and admitted she'd not done sat before turning him up)
- 0Oct 27, '07 by leslymillPulse 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. I think that is what the plan of care is educating use about. Sometimes a PRN breathing TX, inhalers, even sedatives are ordered for these events, but if none of it is working, from a legal standards of practice standpoint I would not leave the pt for an extended period of time while waiting for an MD to return a call and have them higher than what the doctor has ordered. ( I have been yelled at to lower it back to 2L/M before). If they are in an LTC with no R/T to call or breathing tx etc, I would concider calling an ambulance before upping O2 on a COPD pt and just leaving it at that.
- 3Oct 27, '07 by jbtampaGeesh, I am an RT in nursing school, 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!!!!
- 0Oct 27, '07 by RNcDreamsI'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!
- 0Oct 27, '07 by TweetyQuote from jbtampaGeesh, I am an RT in nursing school, 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.
- 3Oct 27, '07 by Angie O'Plasty, RNGenerally 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.
- 5Oct 27, '07 by ginger58Quote 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.