Air vs. Oxygen for breathing trt

[bnurse1988]

Pt's that receive breathing treatment, i.e. duoneb. Which outlet do we use (green vs. yellow) I've seen both used.

I feel like I may be putting my pt at risk for oxygen toxicity if I crank it up to 12-15L of O2.

Is air going to deliver the medication adequately?

Thanks for your input.

[exp626]

Typically you give a breathing treatment on air (yellow). The exception is if the patient keeps removing their O2 and they're desatting, you can put the treatment on oxygen (green) as an alternate way of administering it (but this isn't the first choice for administering oxygen). Obviously you want to be extremely cautious with retainers.

[bnurse1988]

Speaking of retainers, had a nurse turnover to me the other day that my COPD patient was placed on 5L of O2 on a FM. She said that it was totally acceptable because it was a FM and not a N/C...

**FACE PALM**

Thanks for the answer. Will use the yellow port from now on.

[UnaNayeli]

A question as an aside -- not because you said anything incorrect, but because you triggered a thought I carry around: Why do many nurses think all COPDers can't use higher rates of O2? I was taught this is true ONLY of CO2 retainers. While most (all?) C02 retainers are COPDers, not all COPDers are CO2 retainers. Input, anyone?

[exp626]

All people with COPD are not retainers, but they should be treated as such until proven otherwise with an ABG. (Ideally you can find a baseline ABG from earlier in the admission or from previous admissions.)

[Biffbradford]

If you're giving the treatment PRN because the patient isn't able to hold their sats, or is complaining of trouble breathing, then wouldn't you give it with oxygen?

[exp626]

If you're giving the treatment PRN because the patient isn't able to hold their sats, or is complaining of trouble breathing, then wouldn't you give it with oxygen?

Yes you could.

[kiszi, RN]

Pt on O2 nasal cannula can keep it on while receiving breathing tx.

[Emergent, RN]

A CO2 retainer does better with O2 sats 89-92%. He/she may very well need more than 2L NC to accomplish that.

[Christy1019, ASN, RN]

I was taught (and see RTs do the same) that when I'm using oxygen to set it at 6-8L, not 10-12. More often than not I see and administer treatments on oxygen.

[june2009]

We give all of our txs on o2. We don't have air piped into the rooms. Never had a problem.

[sharkdiver]

Unless you have them on high PPO2 levels for extended lengths of time, I wouldn't worry too much about oxygen toxicity.

For example, because they see the highest concentrations of O2, the lungs and the rest of the respiratory tract are the first organs to show toxicity. Pulmonary toxicity starts to occur occur at a PPO2 level > 0.5 bar (50% O2 at normal atmospheric pressure). Symptoms typically appear somewhere between 4 and 22 hours after exposure to greater than 95% O2 concentration, with at least one study suggesting approx. 14 hours at this level. At PPO2 of 2 to 3 bar (100% O2 at 2-3 times atmospheric pressure) symptoms may show in as little as 3 hours.

Slightly off topic:

In scuba diving (note my user name) we deal with this all the time, because a seizure at depth is almost always fatal. Depending on the length of the dive we try to keep the PPO2 between 1.2 and 1.4 bar. Normal atmospheric O2 concentration starts to become toxic at depths greater that 184 FSW, so for dives at greater depths we actually use a hypoxic mixture - the deeper the dive the lower the O2 concentration. I rarely do any tech stuff anymore, and nothing really deep, but my deepest logged dive is 458FSW with a bottom gas of 10% O2 concentration trimix and a bottom time of 10 minutes....followed by a couple hours of staged decompression - the last of which is usually 10-15 minutes on 100% O2 at a depth of 15-20 feet.