anxiety/desats when repositioning intubated patient

Esme12, ASN, BSN, RN · Oct 7, 2012

Is this for an actual patient? I know this is a student question but I think critical care will be helpful to you.....moving for improved response

Chisca, RN · Oct 7, 2012

Oxygen supply must always meet demand or you will have desaturation. If you had a SVO2 monitor in addition to a SPO2 monitor you could see this in action. Bathing and turning a patient consume a tremendous amount of oxygen (increased demand), why not bump up supply if you know this is going to happen?

detroitdano · Oct 7, 2012

Some people just go in and turn a patient and do not tell them what they're doing, freaking the patient out and causing anxiety.

Some patients just don't listen, or don't have the right mind to do so (sedated/encephalopathy) and there's nothing you can do that will decrease their anxiety outside of snowing them with meds.

You can always preoxygenate them for turns, that little bit of 100% oxygen isn't going to cause oxygen toxicity.

If I have someone who consistently desaturates with activity such as baths, I will have our respiratory therapist place the patient on 100% oxygen for the duration of the bath and have them flip them back when done. Problem with this is both the RN and RT are multi-tasking nonstop and might forget about the bump in O2, so leave yourself a note on top of your keyboard in the room, on the vent, or someplace else you'll clearly see your reminder to get them placed back on previous O2 levels.

BelgianRN · Oct 8, 2012

As other posters have said preoxygenation is helpful. But you could see if you have orders to give a bolus of a sedative for an already intubated patient. This will decrease the oxygen consumption by avoiding anxiety altogether an also prevents excessive moving/struggling from the patient while turning him/her which in turn will help with minimizing oxygen consumption.

I'd like to stress too that it's important to check all connections in your ventilatory circuit before turning a patient where derecruitment is a potential problem (e.g. ARDS) to prevent even greater desaturation when performing a manoeuver.

studentmalenurse · Oct 8, 2012

Hi,
I've been looking for some literature on how to reduce anxiety/desats during repositioning.
Just wondering... as I have to place the patient in the supine position for several minutes when repositioning, would it be a good idea to preoxygenate the patient beforehand? Especially since she desats during turning?
I also want to reassure the patient with a calm, soothing voice and explain what I am doing throughout.... but would preoxygenation be helpful? Or is preoxygenation limited to avoid oxygen toxicity?
Any ideas on this issue would be appreciated. Thanks for the help!

Is she experiencing anxiety or is it pain? Ive noticed at times patients on vents not having any medication scheduled for pain. How low does the desaturation go? I made the mistake before of calling a code on a patient who was desating, who was laying on there side. They werent in any distress, I was a new nurse then. Now i know that sometimes if a patient lays on their side they may desat, doesnt necessairly mean they are in distress.

KatieMI, BSN, MSN, RN · Oct 8, 2012

Preoxygenation and even (through respiratory therapist) bumping PEEP for 5 - 15 min. won't hurt lungs that much if patient is on low FiO2 and won't make much difference if he's already on 50% or more, just by common sense.

Absolutely, sedation and pain meds schedules must be checked so that patient could get something right before. For bathing, temperature of room and water must be adjusted b/o cooling of the patient greatly increases oxygen demand.

RNbethy · Oct 9, 2012

Thanks for all the replies. I can see the importance of providing pain meds before turning the patient, but the pt is already getting a fentanyl drip, titrated to the highest ordered level. Also, according to the person who was helping me turn the pt, her oxygen levels aren't dropping that much during turning -- she just hyperventilates and blood pressure rises... (I wasn't actually facing the monitor during the turns; the other nurse was...hence my confusion. Plus as a student, I was a little slow to ask the question...)....

We are explaining to the pt what we are doing, but the pt still gets pretty worked up.... Anyhow, I don't know if the suggestions given will work for this patient.... but I will definitely use them on others. Thanks again :)

ktliz · Oct 15, 2012

KatieMI... I am confused. I thought cooling the pt. DECREASED O2 demand, as in therapeutic hypothermia?