Do you as a Hospice Nurse use a pulse oximeter?

[SoCalRN1970]

I have found that more and more nurses are carrying and using their own portable Pulse Ox. I personally dont' like to use them we all know our patient's pulse ox's will be nothing near normal for the most part... family members often tend to focus on numbers I have found when following nurses who use these.

DO you feel they are appropriate? Most hospice agencies do not provide these items. I feel it's an expense that I don't wish to put out there,but like I said more and more of my colleagues are using these.

What are your ideas on this subject matter?

[twinkletoes53]

The only reason I would want a pulse ox. on a hospice patient would be if his family was not there. I would set the alarm limits very low (e.g. HR 30; pulse ox. 30%). The only reason I would do this is because if the patient was going downhill and looked like he or she may die that night...if family members are not there, it would give me a chance to call them in to be with their loved one when they died.

[twinkletoes53]

"I wont put her though the auto-pilot like intake that slows and frustrates the real matter at hand. She is well sedated 100mcg/h fentanyl patch w 10mg methadone,,,and quiet, comfortable and sleeping. 'massive bone masti.' Anyone watching threads? question must be ' how dangerous are we here?? cath is capped padded and tucked in well.. Sigh."

I am truly, truly sorry for what you are going through. If it were my family member, I personally would not call her nurse or take her to the ER. Especially the way you described your ER. Does your wife have a DNR order? If so, would that not relieve you of any legal dangers? (If that is what you meant when you said "How dangerous are we here?") This is your decision, but if it were my family member and he was comfortable and not in pain... personally I would want to spend my last few moments with him at home, holding his hand, kissing him, and telling him how much I loved him.

I am not married, but it was a nightmare when my father died. I was not there, but I would NOT have called the ER or taken him there when he had his last heart attack. My stepmother took him to the ER. He arrested shortly after arrival, and they performed CPR for over 20 minutes. He was left brain dead. I wish more than anything that he could have died peacefully at home, surrounded by his close family who loved him so much.

[stab88]

Thankyou so much. I guess my real question was about the alarm I sensed after denver-drain procedure. ""after draining 600mls, I saw a some traces of blood in the cath just at the point in enters the chest. (it was faint and pinkish marbled somewhat)"" It does indicate some bleeding in the pural sack.? Could it be minor irritation at the base of the cath tube inside.? I do best to eliminate the cough. However after 2 days of well wishing family members visiting I fear complete exhaustion has aided her deep sleep now.

John

[Hospicetex]

The company I work for now uses and provides them. I really don't like it, but do see the appropriateness of using a pulse ox in the admission process as a general baseline measurement. My thought is why use it on a routine VS? What are we going to do with the information? I think it tends to increase stress in family members who will focus on a number..

[hospicernsrgr8t]

My agency does not routinely provide a pulseox for Hospice HH assessments, however they are available for us to sign out for some more in depth assessments. I have found it usefull, especially with COPD pt's who need to be recertified. I recently had a pt who suffers from depression and spends most of her time in bed, I rarley noticed her dyspneic with or without O2. A pulseox walk test assessment was especially helpful to determine how dependant on oxygen she really was...or if her diagnosis should be considered as end stage for hopice services.

[Ginapixi, BSN, RN]

Interesting!!! 5 years ago, i worked for a different hospice, i was told by management that we are to use our nursing skills to assess oxygen needs and they were not providing any one with P ox - where i work now, we started out with one for the whole office! we had to sign it out; then every nurse seeing patients was provided with one. I agree with the nursing assessment need except for those pts who think they need more O2, but they are satting at 95% or higher and in that case i'd rather not increase O2 flow and then it is good to have that little gadget! Otherwise i agree with all the above and find it rather unnecessary (just as unnecessary as taking a BP on some one imminently dying); a pulse ox reading does not mean good nursing care.

[AtlantaRN, RN]

i own one because my husband had a pe 12 years ago, i purchased one on ebay.

last year, my agency gave each ease mgr a pulse ox to use. we use them at admission and recerts for copd patients, or any patient with a lung anomoly.

[caliotter3]

I recently had a version of this discussion with another nurse at a hospice case. She agreed that although other "new" to the field nurses were using one and charting the data, there was no apparent medical need for the information. Apparently some people are being influenced that the pulse ox reading is another vital sign to be charted, even when not applicable to the patient's circumstances.

[dream-a-little-dream]

I'm a new Hospice nurse, and yes, I feel they add to our routine visits or any other time of assessment; we can suggest patients use their supplemental PRN O2, or get O2 on board when appropriate. As a Hospice nurses we have the goal of quality of life for our patients, and if we know by a simple 30 second reading that they are compromised with their oxygen, how is that helpful?

[tewdles, RN]

When I first came to hospice I thought I would want a pulse ox. I quickly learned that the patients who would need that information to be more comfortable own their own. And, they are often fixated and anxious on the numbers...which increases their dyspnea in some cases.

So, I think it is not a critical, or expensive item for a hospice agency. If a specific nurse wants a pulse ox as his/her own professional equipment, they are easy and cheap to get . Definitely not the investment that we put into a good stethascope or otoscope for instance.

[CJsGirlRN]

I check the pulse ox once in a while just to see if there has been any decline in the respiratory status, especially when a patient's recertification is coming soon. I have found too that in some patients who are not end stage resp disease have needed the o2 because i checked their pulse ox and it was significantly low. it helped with their perfusion, especially when they complain of cold hands and feet. I've considered getting my own but we have one we can borrow from our office when we need to.

[curiousauntie]

We have 2 POx in our office that for months were hardly used until recently when an audit by corporate showed we needed to tighten up our documentation for eligibility. So now they are ordering one for each of us. I have no problem using it. I would never titrate O2 to a pulse ox, especially in a COPD patient. But the pulse ox does give me the numbers I need for documentation and the back up documentation for the patient that says they are "winded" at rest without oxygen on.

I have not had a family obsessing about the numbers...yet. I also do as one other poster said. I put it on, get the reading and pull it off. I do it as part of the vital signs, so it seems like just one more piece of equipment...BP cuff, stethoscope, POx, measuring tape.

As to the question of what would I do with the information? Depends on if there are increased respiratory symptoms. Cyanosis and SOB where it wasn't before? Find the cause and try to fix it, if possible. That then becomes symptom management, what we hospice nurses do.