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

  1. 0 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.
  2. Visit  ChristopherH profile page

    About ChristopherH

    Joined Mar '07; Posts: 14; Likes: 22.

    62 Comments so far...

  3. Visit  RedCell profile page
    7
    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.
    Try that 2 LPM gimmick when that COPD dude has SpO2 sats in the 60's is as blue as Casper and hypoxic as hell. They will be showing you the Q sign and going to meet Jesus in no time. Seriously, that old school nursing instruction is way behind the eight ball on modern day practice. The truth is, you give those guys what they require to maintain homeokinesis. Whether that is 2 LPM, a nonrebreather, or a new extension of their trachea attached to a blower....give them what they require. For references try looking in any physiology textbook copyright 2000 and beyond.
    Last edit by sirI on Oct 27, '07 : Reason: TOS
    feral5, kanzi monkey, nuangel1, and 4 others like this.
  4. Visit  RedCell profile page
    2
    Actually, try reading Respiratory Physiology The Essentals 7th ed. by John West. That guy literally wrote the book on understanding this stuff. It is a quick read so if you bring it with you while in the can you will be done in no time.
    LoveLTC and PageRespiratory! like this.
  5. Visit  LaeDeesNP profile page
    0
    If I'm remembering correctly, I believe I was taught in school that a COPDer can not be on anything greater than 6L because anything greater than that will only adversely effect their respiratory effort.
    However, I'm sure there are exceptions to the rule as nothing in medicine is set in stone.
  6. Visit  ChristopherH profile page
    0
    Quote from RedCell
    Actually, try reading Respiratory Physiology The Essentals 7th ed. by John West. That guy literally wrote the book on understanding this stuff. It is a quick read so if you bring it with you while in the can you will be done in no time.

    LOL...good info. I actually looked in my medical surgical nursing book beforehand (smeltzer and bare, copyright 2004) and read the pertinent information, but the info was rather generic and it didn't say anything as far as what is too much O2 and what is too little, just the basics about "if you give too much it will suppress their repspiratory drive etc. etc." but nothing about where that threshold actually lies. As I said, i suspect that it's entirely individualized. I would think that the worse their degree of pulmonary obstruction is, the more CO2 they will retain, therefore the less O2 you can give them without suppressing their respiratory drive. I would think that the only way you could determine this on an individual basis would be by aggessively check their O2 sats with each change. But I don't know if there is a specific level that your general person with COPD absolutely cannot go above.
    Last edit by ChristopherH on Oct 27, '07
  7. Visit  PageRespiratory! profile page
    11
    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".
    Last edit by PageRespiratory! on Oct 27, '07 : Reason: my fingers still won't listen to my brain.
    feral5, jnette, nuangel1, and 8 others like this.
  8. Visit  PageRespiratory! profile page
    1
    NOBODY should EVER be on more than 6L by NC.
    Angie O'Plasty, RN likes this.
  9. Visit  leslymill profile page
    1
    I 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.
    respRN86 likes this.
  10. Visit  PageRespiratory! profile page
    4
    While I agree with closley monoriting and consulting co-workers, I gotta ask; if your Pt is 70% by pulsox, tachypenic (not neccessarily hyperventilating mind you), and cyanotic on 2L, you're not going to turn them up right away?!?!?!? So the MD writes an order to "maintain sats 88% - 92%, what if it takes an NRB to acheive? Would you still only give them 2L? Just asking.
    Last edit by PageRespiratory! on Oct 27, '07 : Reason: the whole fingers rebelling from the brain thing
    feral5, nuangel1, Altra, and 1 other like this.
  11. Visit  ChristopherH profile page
    2
    Quote from PageRespiratory!
    While I agree with closley monoriting and consulting co-workers, I gotta ask; if your Pt is 70% by pulsox, tachypenic (not neccessarily hyperventilating mind you), and cyanotic on 2L, you're not going to turn them up right away?!?!?!? So the MD writes an order to "maintain sats 88% - 92%, what if it takes an NRB to acheive? Would you still only give them 2L? Just asking.

    Good point. And in my case, I work in a nursing home. There aren't doctor's around every corner in long-term care, and they can be difficult to reach in general. You also aren't going to be getting ABGs on a patient who's in such a facility, the best you have to go on is your pulse oximeter.
    Last edit by ChristopherH on Oct 27, '07 : Reason: better wording
    feral5 and Angie O'Plasty, RN like this.
  12. Visit  EmmaG profile page
    0
    Quote from PageRespiratory!
    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".
    Exactly. I've seen them placed on a NRB over a cannula...'course by that point, it's pretty much an exercise in futility.

    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)
  13. Visit  sharona97 profile page
    0
    I just loved it when an RT would wisp by me and tell me my patient she just did a treatment on is in the 40"s for HR. and then leave the floor...........I know I'll get flamed, but the guy coded just as she got the words out and split. Grrrrrrrrr.
  14. Visit  leslymill profile page
    0
    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. 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.

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