Nurse manager said O2 concentrator can be used with BMV?

Nurses General Nursing

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He was doing CPR renewal with us.

This can't be true,or is it?

He also said he never heard that you need at least 15L of oxygen to inflate the bag.

He said 2L of O2 is fine.

Private duty supervisors really have me scratching my head.

I actually saw a nurse chart that she used 2L of oxygen from the concentrator for the Ambubag.

I work with trach/vent kiddos in the home. We do not have to be PALS trained.

What is the minimum oxygen you need for a BMV?

I read 10L. I also read that you can't use a concentrator. That takes time to heat up,and you do not have time in an emergency for that.

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

Hi,

In a code situation, or if the patient is being ventilated because of hypoxia the flow should be 15 LPM of oxygen, but you could probably get away with 10 LPM.

If you are ventilating a patent because there is a problem with their ventilator or for another non-emergent reason you can ventilate on room air. Your BVM should come with an instruction manual which will state how many liters equals what percentage of oxygen. If there is no oxygen then you are ventilating with room air which is ok for certain situations as stated, but not in a cardiac arrest.

Bottom line if all you have is whatever you concentrator can give you then just do your best, ventilations with less oxygen is better than none!

Annie

But what kind of "bag" are you talking about? Still confused.

Ambubag for the most part.

The order is for O2 prn,up to 5L/minute in 0.5 L increments to maintain oxygen saturation greater than 92%.

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Does the family leave the oxygen concentrator on around the clock, if as you maintain it can take as long as 10 minutes for the oxygen concentrator to start "kicking out oxygen?" I would hope so, as this long a delay in providing supplemental oxygen in a decompensating patient could lead to severe decompensation.

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A similar question was asked before and most agreed 2L was a waste,esp with a concentrator.

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No, most did not agree with 2 LPM was a waste. KP2016 suggested that "2L is not enough to inflate the bag or clear the carbon dioxide;" neither of which is applicable if you are using a self-inflating resuscitation bag. Again, if you are using a self-inflating resuscitation bag it will expand by natural recoil after being released. Then you questioned whether giving 2 LPM oxygen via oxygen concentrator could cause more harm than good. I asked you how you thought it might and am still waiting an answer.

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I do know most concentrators take some time to start producing oxygen.

They are not like tanks,which has o2 for immediate use.

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Yes, thank you, I am well aware of the difference between an oxygen concentrator and a portable oxygen tank. My question here is this, what are you basing your assumption that most oxygen concentrator "some time to start producing oxygen?" Other than the fact that an RT told you that "they take 10 minutes to start actually kicking out oxygen?" Have you actually read the operators manual for the oxygen generator in use?

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One supervisor,same agency,told me 10 to 15L but she said never,ever use a concentrator because they do not produce oxygen fast enough. Always use the tank,and most homes with a concentrator do have back-up oxygen tanks. She said oxygen gives better perfusion.

She actually was PALS certified.

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Again, while I agree that ventilating the patient supplemental oxygen, particularly in the setting of cardiorespiratory compromise or arrest, is optimal, why do you think that it is necessary? That is one of the reasons that self-inflating resuscitation bags are used almost exclusively. And, if they are using a flow-inflating bag there should be a back-up self-inflating bag in the event that the gas source is lost. This is what we do where I work, even though if we lose the main oxygen system we always have a portable gas source available.

As to someone being discharged home with an oxygen requirement on an oxygen concentrator without an alternate gas source, I find this difficult to believe. All patients discharged from my facility with an oxygen requirement and oxygen concentrator have a portable oxygen source available for power outages and transports.

And exactly how does oxygen give better perfusion?

Ambubag for the most part.

Okay that helps. So you could run O2 from a concentrator into an ambu bag. It might help and is unlikely to hurt unless contraindicted for the patient. It won't affect the functionality of the bag but it also will only marginally increase the concentration of inspired O2 at 2lpm. The instructor is correct (well sort of) that you don't need to run O2 to an ambu bag because it's self-inflating. That's why he's never heard of it. But if the patient needs a high concentration of O2 then you will need that 10-15 lpm of supplemental O2. Regardless, in an emergency, bagging with room air is better that not bagging at all.

Specializes in ICU.

ambubag can be used without oxygen. if all you have is a concentrator and can turn it on and use it eventually something is better than nothing. if theres a tank use that. but you can bag without oxygen if its all you got.

A NRB mask requires minimum 10-15L of flow to inflate the bag and prevent rebreathing of carbon dioxide. thats where the flow is important.

oxygen doesnt give better perfusion. CPR and cardiac output is what perfuses your cells. oxygen just provides oxygen to the cell. and to get to the cell you deliver it (perfuse) with a beating heart or CPR

Specializes in 15 years in ICU, 22 years in PACU.

The OP mentioned a BMV so I will address that.

He/she probably meant a BVM (Bag Valve Mask) which is a generic name for an Ambu Bag. "Ambu" is a trade name.

A BVM is a self-inflating bag that doesn't need a flow of oxygen to keep it inflated. When doing CPR you use the bag to push air into the non breathing patient's lungs. Ventilation is happening here on room air which is 21% Oxygen. Any amount of additional oxygen whether intermittent, 2L, 10L, 15L is helpful but not necessary.

Uhhh, kinda what PPs said.

The "bag" or "tail reservoir" of a BVM (Ambu) helps increase the concentration of oxygen. It has very little to do with CO2 since the exhalation is through the spot where you place a PEEP valve if you have one.

If a concentrator (5- 8 L) is all you have to provide O2, use it. At least you will have more than 21% for oxygen. However, a concentrator will not work with a flow inflating bag (neonates, Jackson-Rees bag).

For oxygen sensitive kids, we have been known to remove the reservoir bag or tail and attach the O2 line directly. With the air entrainment through the end, the FiO2 is reduced to 0.35 to 0.40 with 10 to 15 L O2 attached depending on the size of BVM used.

Does the family leave the oxygen concentrator on around the clock, if as you maintain it can take as long as 10 minutes for the oxygen concentrator to start "kicking out oxygen?" I would hope so, as this long a delay in providing supplemental oxygen in a decompensating patient could lead to severe decompensation.

No, most did not agree with 2 LPM was a waste. KP2016 suggested that "2L is not enough to inflate the bag or clear the carbon dioxide;" neither of which is applicable if you are using a self-inflating resuscitation bag. Again, if you are using a self-inflating resuscitation bag it will expand by natural recoil after being released. Then you questioned whether giving 2 LPM oxygen via oxygen concentrator could cause more harm than good. I asked you how you thought it might and am still waiting an answer.

[...]

Yes, thank you, I am well aware of the difference between an oxygen concentrator and a portable oxygen tank. My question here is this, what are you basing your assumption that most oxygen concentrator "some time to start producing oxygen?" Other than the fact that an RT told you that "they take 10 minutes to start actually kicking out oxygen?" Have you actually read the operators manual for the oxygen generator in use?

Again, while I agree that ventilating the patient supplemental oxygen, particularly in the setting of cardiorespiratory compromise or arrest, is optimal, why do you think that it is necessary? That is one of the reasons that self-inflating resuscitation bags are used almost exclusively. And, if they are using a flow-inflating bag there should be a back-up self-inflating bag in the event that the gas source is lost. This is what we do where I work, even though if we lose the main oxygen system we always have a portable gas source available.

As to someone being discharged home with an oxygen requirement on an oxygen concentrator without an alternate gas source, I find this difficult to believe. All patients discharged from my facility with an oxygen requirement and oxygen concentrator have a portable oxygen source available for power outages and transports.

And exactly how does oxygen give better perfusion?

There was a thread about COPD pts on this some years back and the answer i got was that you need 10L of oxygen for an Ambubag.

https://allnurses.com/general-nursing-discussion/ambu-bag-with-533590.html

Oxygen concentrators do not stay on all the time.

I also literally typed that most kids have an oxygen concentrator and back up O2 tanks.

Most of the kids I do care for aren't on oxygen 24/7. It is there on a prn basis if sats fall below a certain threshold.

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I also literally typed that most kids have an oxygen concentrator and back up O2 tanks.

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My apologies, I misread that post as you stating that your supervisor telling you that a backup oxygen tank was available.

Yes, if an oxygen source is available, and the patient requires ventilator support with a BVM, supplemental oxygen should be used.

Specializes in critical care, ER,ICU, CVSURG, CCU.

Ok, since I an a RN. & RRT:

If concentrator is on, it's already producing oxygen at FiO2 of 90-95% at outlet, the flow meter regulates end FiO2.

The flow meter should be turned to Max, for most that is 8L/M, Some concentrators have higher flow capabilities.

Attaching ambu to it delivers ~ 70-80% fio2 at 8L/min.

But you can ventilate on room air, which has a fio2 of 21%...... Better to have some % of oxygen, but it is circulation, wherethe patient's heart function, or cpr chest compressions, that perfuses.

Ok, since I an a RN. & RRT:

If concentrator is on, it's already producing oxygen at FiO2 of 90-95% at outlet, the flow meter regulates end FiO2.

The flow meter should be turned to Max, for most that is 8L/M, Some concentrators have higher flow capabilities.

Attaching ambu to it delivers ~ 70-80% fio2 at 8L/min.

But you can ventilate on room air, which has a fio2 of 21%...... Better to have some % of oxygen, but it is circulation, wherethe patient's heart function, or cpr chest compressions, that perfuses.

WHat if the 02 concentrator was off though?

Doesn't it take some time after being turned on to produce oxygen?

WHat if the 02 concentrator was off though?

Doesn't it take some time after being turned on to produce oxygen?

No. It starts producing oxygen immediately but it takes 10-15 minutes for it to deliver the highest concentration it is designed to deliver(usually 90-95%).

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