How many liters of O2 can a patient with COPD be on?

[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.

[PageRespiratory!]

....................and the misinformatin continues to flow.

[Tweety, BSN, RN]

....................and the misinformatin continues to flow.

Not a very helpful post, unless you clarify. Thanks.

[crissrn27, RN]

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:o), 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!

[CraigB-RN, MSN, RN]

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.

[crissrn27, RN]

Another thing about my dad. His resting sats are around 88%. His "working" sats can drop into the 70's. He has to be very, very SOB, with cyanotic lips, for him to stop what he is doing and rest. The man still mows my lawn, and weed-eats, and works as a traveling mechanic for the company he retired from, part-time! He tolerates his low sats very well, and has, thus far, refused any home O2.

[cardiacRN2006, ADN, RN]

The hypoxic patient gets as much O2 as they need.

When I read the title of this thread, I immediately thought, "as much as they need".

If they lose their hypoxic drive, then we can correct that. But it's a whole lot harder to correct hypoxia/brain damage/death.

[leslie :-D]

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

if you have a pt in resp distress, the nurse would be continually assessing the pt, never leaving their side. isn't that a given?

leslie

[cardiacRN2006, ADN, RN]

I find nurses who practice medicine without a license and arbitrarily bump up patients oxygen a bit frigthening as well.

I don't consider this practicing medicine. It's a titratable medication just as much as any other kind.

Don't most people have it written in their orders "O2 @ blank, titrate to keep sats at Blank....?

[RainDreamer, BSN, RN]

I don't consider this practicing medicine. It's a titratable medication just as much as any other kind.

Don't most people have it written in their orders "O2 @ blank, titrate to keep sats at Blank....?

We can titrate the FiO2 to keep sats WDL, but not the liter flow. If they're requiring more liter flow, we need a doctor's order. But that's in the NICU, I'm not sure about adults.

[cardiacRN2006, ADN, RN]

We can do both.

Our orders for non-intubated pts says, "O2 via NC at 2lpm, titrate to keep sats >92%". I've seen it say lower sats for COPD pts.

[ginger58, ASN, RN]

Originally Posted by 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.

Titrating oxygen with an order is practicing nursing with a license and proudly. I have never thought of 90% sat as being hypoxic and I could not find any definition stating such. I think it depends on the patient's condition and/or ABG.

[FireStarterRN, BSN, RN]

I forwarded this thread to a pulminoligist I work with, I hope he reads it and gives me some feedback.