Nurse manager said O2 concentrator can be used with BMV?

  1. 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.
    •  
  2. Visit smartnurse1982 profile page

    About smartnurse1982, RN

    Joined: Jun '08; Posts: 1,777; Likes: 1,286

    31 Comments

  3. by   kp2016
    Oxygen needs to be continuous flow, not intermittent like some concentrations supply. Flow should be a minimum of 10-12 L. I can't comment on the time it takes a concentrator to "heat up". If that's all you have I would suggest you call from help/ activate 911 them turn it on and use it as soon as it is available. Having said that it is my understanding that 2L is not enough to inflate the bag or clear the carbon dioxide which will lead to increased CO2 levels and reduced oxygenation.
    I would also review your facility guidelines on management of respirator/ cardiac arrest and follow your facilities guidelines. If you don't have a policy and they are using the "Follow the American Heart Association guidelines" I would very respectfully campaign to management to get a policy written, one that speciafically addressed the equipment that you do have available.
  4. by   Guy in Babyland
    In an ideal world you should use 10 liters, but if you are at someone's house and the only oxygen you have is a concentrator, it is better than using room air.
  5. by   smartnurse1982
    Most concentrators only go up to 5-8L of oxygen.

    I had an RT tell me they take 10 minutes to start actually kicking out oxygen.
    I know that BMV could be used without oxygen,but if the only thing available is an o2 concentrator why waste time turning it on in an emergency?

    Does giving 2l of O2 through the concentrator cause more harm than good?

    I see someone above wrote it causes more carbon dioxide?
  6. by   chare
    When you refer to inflating the bag, which bag are you referring to? If you are using a self-inflating resuscitation bag, it doesn't require any oxygen to use and refills by recoil after the bag was squeezed. If you are referring to the clear reservoir bag that some devices have, it may or may not fill depending on size of the BVM and ventilatory rate. As for minimum oxygen required for use with a BVM, there is none. Depending upon patient condition, and why he or she requires ventilatory assistance, supplemental oxygen might be appropriate and helpful, but there is no minimum amount required. And when you consider that most pediatric cardiopulmonary failure and/or arrests are respiratory driven, ventilation with room air is better than none, and might be sufficient to recover the patient.
  7. by   chare
    Quote from kp2016
    Oxygen needs to be continuous flow, not intermittent like some concentrations supply. Flow should be a minimum of 10-12 L. I can't comment on the time it takes a concentrator to "heat up". If that's all you have I would suggest you call from help/ activate 911 them turn it on and use it as soon as it is available. Having said that it is my understanding that 2L is not enough to inflate the bag or clear the carbon dioxide which will lead to increased CO2 levels and reduced oxygenation.
    I would also review your facility guidelines on management of respirator/ cardiac arrest and follow your facilities guidelines. If you don't have a policy and they are using the "Follow the American Heart Association guidelines" I would very respectfully campaign to management to get a policy written, one that speciafically addressed the equipment that you do have available.
    Why do you think that oxygen flow needs to be continuous? And which bag are you referring to? If you are using a self-inflating resuscitation bag there is no requirement for any gas flow to make the bag work. If you are referring to the clear oxygen reservoir, it may or may not fill depending on bag size of ventilatory rate. As for clearing carbon dioxide, every time you squeeze the bag, with or without a supplemental oxygen source, any carbon dioxide that accumulated is going to be cleared from beneath the mask. I agree that 2 LPM oxygen flow might be insufficient, however in the setting of cardiopulmonary failure or arrest, ventilation with room air or minimal oxygen flow is better than no ventilation at all. And, as most pediatric cardiopulmonary failure and/or arrests are respiratory based, ventilation with room air or minimal supplemental oxygen is definitely helpful and might be sufficient to recover the patient. Regarding hypercarbia and hypoxemia, one doesn't necessarily lead to the other and each can exist in isolation.

    Definitely agree that there should be some policy regarding equipment and resuscitation procedures.
  8. by   chare
    Quote from smartnurse1982
    Most concentrators only go up to 5-8L of oxygen.

    I had an RT tell me they take 10 minutes to start actually kicking out oxygen.
    I know that BMV could be used without oxygen,but if the only thing available is an o2 concentrator why waste time turning it on in an emergency?

    Does giving 2l of O2 through the concentrator cause more harm than good?

    I see someone above wrote it causes more carbon dioxide?
    As I am unfamiliar with the use of an oxygen concentrator, I will accept you premise that most concentrators only go to 5 – 8 LPM. However, do you know that to be the case with the concentrator that your patient is using? As for the RT telling you that it takes 10 minutes to start producing oxygen, do you know that to be the case with this particular concentrator? And if the patient has an oxygen requirement, with a concentrator at home, wouldn't you think it likely that it would be on? Even if it weren't on, and it takes some time to generate maximum flow, don't you think some supplemental oxygen would be better than none? And as to 2 LPM oxygen causing more harm than good, what do you think? And why
  9. by   Wuzzie
    Quote from kp2016
    Having said that it is my understanding that 2L is not enough to inflate the bag or clear the carbon dioxide which will lead to increased CO2 levels and reduced oxygenation.
    I'm very confused. Are you talking about a non-rebreather mask or a self-inflating bag resucitator? If it's the former then what you're saying about ventilation is true but if it's the latter then it doesn't matter if you have 0 or 15 lpm going through it. Ambu bags have a one way exhalation valve so no expired CO2 goes into the bag.
  10. by   Kitiger
    Quote from Wuzzie
    I'm very confused. Are you talking about a non-rebreather mask or a self-inflating bag resucitator? If it's the former then what you're saying about ventilation is true but if it's the latter then it doesn't matter if you have 0 or 15 lpm going through it. Ambu bags have a one way exhalation valve so no expired CO2 goes into the bag.
    Exactly. The high flow is necessary with a non-rebreather mask. But you don't use a non-rebreather mask to resuscitate a person. For that, you need something that will force air into the lungs, ie, a BMV.
  11. by   smartnurse1982
    Quote from chare
    As I am unfamiliar with the use of an oxygen concentrator, I will accept you premise that most concentrators only go to 5 – 8 LPM. However, do you know that to be the case with the concentrator that your patient is using? As for the RT telling you that it takes 10 minutes to start producing oxygen, do you know that to be the case with this particular concentrator? And if the patient has an oxygen requirement, with a concentrator at home, wouldn't you think it likely that it would be on? Even if it weren't on, and it takes some time to generate maximum flow, don't you think some supplemental oxygen would be better than none? And as to 2 LPM oxygen causing more harm than good, what do you think? And why

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

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

    I do know most concentrators take some time to start producing oxygen.
    They are not like tanks,which has o2 for immediate use.
  12. by   smartnurse1982
    As far as a written policy and procedure,there is none.

    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.

    But homecare is different of course.
  13. by   Wuzzie
    But what kind of "bag" are you talking about? Still confused.
  14. by   AnnieOaklyRN
    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

close