How many liters of O2 can a patient with COPD be on - page 3

by ChristopherH

94,291 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


  1. 1
    as 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)
    Angie O'Plasty, RN likes this.
  2. 0
    What about the ventimask? Isn't that the solution for CO2 retainers who are hypoxic?
  3. 7
    If I am ever hypoxic and you are my nurse ... unless we all agree that it's probably my day to die ... please, please ...

    TURN

    UP

    THE

    O2

    Thanks much.
    llltapp, nuangel1, ginger58, and 4 others like this.
  4. 1
    Quote from leslymill
    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.
    Can 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?

    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.
    Angie O'Plasty, RN likes this.
  5. 0
    CPAP 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
  6. 3
    Quote from ginger58
    I 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.
  7. 4
    Quote from Tweety
    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.
    Tweety, you raise an important point. This question has been debated in previous allnurses.com threads.

    There are 2 scenarios here ...

    1) The COPDer who does indeed tolerate SpO2 of 88-90% or so ... at rest and at baseline. Absolutely these patients should be on the minimum of O2 necessary to continue to be asymptomatic per their baseline. I was once a clueless student who on day 1 of hospital clinicals tracked down my RN because the patient's SpO2 was 91%. I was given an *enthusiastic* refresher lesson on the COPD disease process ...

    2) The other scenario is some respiratory distress, or even a chronic COPDer who has now deviated from baseline d/t fever, pain, exertion, etc. There are posters here at allnurses.com who firmly insist that even in this scenario they would not turn up O2 or would only titrate it in tiny increments. As I now spend time on an ambulance working towards being a pre-hospital RN, I have arrived at LTC facilities to find patients nearly thrashing in bed, cyanotic ... and on a whopping 3L of O2.

    These nurses do indeed frighten me.
  8. 1
    Thanks MLOS, I think we're in agreement here. It is indeed frightening how uneducated we can be in this matter.
    Angie O'Plasty, RN likes this.
  9. 0
    I was just discussing this with a very experienced RT yesterday. He told me that if you know you are getting close to knocking out their respiratory drive to breathe if their O2 sats do not change despite increase in upping the O2. He said this is a very rare occurance, but you have to be especially careful with COPDers that have had the disease for several years.
  10. 4
    May I interject with some physiology here- Central respiratory receptors are what everyone is worried about when talking about copder's and oxygen. These receptors are less sensitive to changes in CO2 as disease progresses, thus "hypoxic drive" peripheral receptors take over respiratory stimulus over extended disease progression. Everyone agrees on this, No?
    Everyone can also agree that oxygen is a neccessary molecule for life maintenence, no?
    Now, as obstructive disease progresses the body "tolerates" lower Spo2's due to a shift to the right (increased CO2) of the dissociation curve which effectively allows for better tissue extraction of O2 from Hgb. This does have it's limits though, as oxygen does have to be initially available for extraction.
    SO... a compromise for all views as follows:

    First rule of health care:Increase your FiO2 as high as you want for any patient exhibiting Hypoxia (Circumoral cyanosis, SpO2<88%, etc.)

    Second rule:Be aware that when you do this you are responsible for monitoring the patients response to the therapy. For those of us in outpatient settings, this may mean calling 911.(Nursing 101)

    Third rule: If rule 1 patient happens to be a COPD person, continue to kick and scream up the chain of command until someone intervenes for and fixes whatever is causing said decompensatory need for increased FiO2, but do NOT deny the patient oxygen. (People can be intubated and mechanically ventilated if they lose their respiratory drive, but it is real hard to raise the dead. Not impossible, just reeeaaaalll hard.)
    llltapp, nuangel1, Altra, and 1 other like this.


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