congential heart defects question

[sweetieann]

Hello PICU nurses!

I have a question. I am currently in a Peds class and we are learning about CHD's. I know with, for example, hypoplastic left heart syndrome you do not want to give supplemental oxygen so you don't close the PDA (which normally closes when baby takes first breath and lungs fill with oxygen). However, do you want to avoid giving supplemental O2 with all children with CHD's, or only in some specific congenital heart disorders?

Thanks for any help!

[NotReady4PrimeTime, RN]

Great question! There are other situations where using 100% oxygen is not a great idea. For example, kids with Blalock-Taussig shunts (for pulmonary atresia with intact ventricular septum, tetralogy of Fallot, transposition of the great vessels) should never be ventilated with 100% oxygen; it causes pulmonary vasodilation and flooding of the lungs, leading to backflow of blood from right to left (shunting) that may potentially become emergent or fatal. Any cyanotic defect that is duct-reliant for adequate oxygenation requires judicious oxygen administration.

[bwpcicuube]

Please remember though that if any child comes in with a Sat below 55% requires O2. Don't withhold O2 just because you think it is a CHD. If a blender is available you may be able to gice 30 - 50 % O2 instead.

[AliRae]

Please remember though that if any child comes in with a Sat below 55% requires O2.

Not necessarily. We have one kid on the unit with complete pulmonary atresia (cool case ... he grew collaterals off his aorta to his lungs and is thus still kicking), and when he desats below 60, we don't give him O2. The most we do for him is slap on a NC with flow, but alway RA. He shunts really badly when he gets too much O2.