How many liters of O2 can a patient with COPD be on - page 4

by ChristopherH 100,992 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. 0
    In order to answer this question the type of O2 therapy being implemented should give you that answer. For example from the Fundamentals of Nursing, Craven text 5th edition, p. 855 outlines the device and the % of O2 capability. For ex: with the nasal cannula device the O2 capacity is 22% - 44% when operated at 1 -6L/min with an emphasis that O2 concentration varyies depending on the patients breathing pattern. With the simple mask device (40% - 60% when operated at 6 -10L/min) it is suggested that this route not be used in a COPD patient because of potential for excessive oxygenation. This was a long winded response... goes hand and hand being a first year nursing student. I hope I am on the right track in answering this question.
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    if you got a COPD'er on more than 2-3 liters, you better be assessing them for mental status changes. IF they are sleeping, wake em up and really check em for loopiness, if they are gettin loopy, you need ABG's, Bipap, or a vent, also some breathing treatments, steroids, etc....
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    because we all *know* high flow O2+Copd, can cause increase CO2 retention, which = loopiness (mental status changes). which = ABG time, get the CO2 down to WNL before the pH drops to incompatibility with life.
  4. 3
    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.
    Very good post- especially the part about the COPD'er tolerating sats at 90%. Lots of COPD'ers stay in that range.
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    interesting that you can read a lot of literature amongst the specialists, about o2 levels.
    most do support giving more oxygen but there are a handful that do not.
    my take on it?
    forget the numbers and your didactics, and crank that baby up!
    monitor your patient and not the machine!
    until they get medically stabilized, you give them the max.
    long-term, hi-flo will kill them.
    but in a crisis situation, 3 lpm will also kill them.
    if they are gasping for air, then GIVE THEM THE AIR.
    yes...common sense.

    leslie
    Angie O'Plasty, RN, Altra, crissrn27, and 1 other like this.
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    One thing I will always do is coach the patient on breathing. I will tell them to concentrate on a long exhalation, reminding them that their main problem is getting old air out so they can get the new air in. I'll demonstrate and breathe with them, telling them that their exhalation should be twice as long as their inhalation. It really helps to remind them of this and they always appreciate it.

    I'm alway surprised how many COPDers have never been instructed in purse lipped breathing....
    Angie O'Plasty, RN likes this.
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    ....................and the misinformatin continues to flow.
  8. 7
    Quote from PageRespiratory!
    ....................and the misinformatin continues to flow.
    Not a very helpful post, unless you clarify. Thanks.
    nuangel1, leslymill, cardiacRN2006, and 4 others like this.
  9. 0
    Quote from jlsRN

    I'm alway surprised how many COPDers have never been instructed in purse lipped breathing....
    My dad is a COPD'er (50 years on Kool's), and I don't know how many times I have coached him on pursed lipped breathing. Gets throught one SOB, cyanotic spell, and the next time, I gotta coach him again. He seems to panic, and not remember!
  10. 3
    Quote from ChristopherH
    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 that she was told that it shouldn't go over 2 Liters however. What is the correct answer, or is it one of those things that is more individualized to meet the needs of the specific patient? Also if anybody has any good sources or links to studies for this info it would be a bonus.
    The hypoxic patient gets as much O2 as they need. There is no limit. now that being said if your giving the COPD patient lots of O2, you have to watch for decreased resp drive.

    In most places when you move past a NC on a COPD patient you go to a Venti mask, BiPAP or a tube depending on what is going on.

    One thing for sure, if you move past a couple of L/M you need to be assessing your patient pretty frequently.


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