ambubag

[Sepanx]

Hi to all the experts! Please I just need help to see if what I did was literally useless and can cause harm:nurse: I have a pt. in LTACH, she was on traech collar, 35%, we were changing her after a BM and after we turned her she became hypoxic, purplish, initially 80's then 70's and sats went down to 66%. She still has spontaneous breathing. I bagged her through her traech but the tubing was not connected to the oxygen source, which I totally forgot. We hit the staff assist button, and RT came and shouted that O2 was not on. Now, I feel useless manually bagging her because I thought ambu bag can be use even if it is not connected to the oxygen source.

Can ambubag be used during this case without being connected through the oxygen though?thanks!

[calivianya, BSN, RN]

In this case, I'd say bagging her without O2 wouldn't have helped much, since she was still breathing. (I'm assuming at a good rate?)

Bagging without O2 would really only be helpful if the patient's own respiratory drive was the problem - like if that last push of IV dilaudid dropped the respirations to 4/minute or something. And even then, bagging with oxygen would be more helpful than bagging without it.

Bagging in general can cause harm, but it's at times a necessary evil. Don't beat yourself up. At least you did something instead of just standing there and waiting for help. :) And I bet you'll hook the bag up to oxygen next time!

[RotorRunner]

If you use the ambu bag without it being attached to an O2 source, you are essentially bagging the patient at room air, which is about 21% O2. This would be better than the patient NOT breathing at all, but not especially helpful if the patient is breathing on their own and just needs O2. Also keep in mind that you have to be very careful with bag mask ventilation. Gastric distention is common, which causes vomiting. Also, barotrauma is very possible if you don't know how firmly to squeeze the bag.

I listened to a podcast once called "BVM as a murder weapon". It's on Emcrit. Might be a good listen for reference.

In any case NO ONE should have shouted at you. It is a common error not to hook up the O2. And if you think the patient needed manual ventilation then you probably made the right call.

[Double-Helix, BSN, RN]

A patient with a trach isn't going to get gastric distention during bagging because the tracheostomy is below the epiglottis. Patients bagged via facemask are at risk for gastric distention because air is forced into both the esophagus and lungs when a breath is delivered.

A self-inflating bag (commonly called ambubags) can be used without an oxygen source. But, as others have said, using these bags without oxygen is really only helpful if the patient is not breathing or not breathing adequately. Your patient was breathing, but not oxygenating well, so what she really needed was more oxygen. If 35% was her normal O2 requirement, bagging her with 21% isn't going to help her.

It's also important to assess WHY the patient suddenly became hypoxic. Did the trach get occluded when she was turned, preventing her from getting any air? Did the trach become displaced? Was there a mucous plug that required suctioning? Asking questions like that help you get to the root of the event and correct it more quickly.