Hospice Oxygen Therapy

NursePaula · Dec 16, 2003

What a pt advocate you are! Good for you! I worked Hospice here in N. California for a few years so I have a little knowledge here. My first question is, was the pt anxious or was the caretakers anxious about the O2 sats dropping? I have seen it go both ways about oxygen and I think that sometimes as a pt is obviously dying it is better not to check the sats. Typically the family becomes concerned that "we should do something". Isn't it more humane to not prolong life at that point if sats are dropping and if the pt is anxious usually if on Hospice anxiety could be helped with maybe a small dose of Ativan or whatever MD has ordered...and then if the sats are continually checked how high do we go on O2??? I can tell you absolutely that a high flow of O2 into ANYONE is usually very agitating and annoying. So...to make a long story short...(finally), I think that after watching many people die in many different circumstances, I hope that NO ONE turns up my O2 when the time comes..... :nurse:

Hellllo Nurse · Dec 16, 2003

I worked inpt hospice for 4 years. We had many pts on up to 15 liters (not a typo, that's 15 L) of 02 regularly. We (and our med director) saw this as a comfort measure and I do not feel that it prolonged dying in any way.

Tweety, BSN, RN · Dec 16, 2003

Very good question and I can't answer that. And look forward the hearing the answers.

I think towards the very end as the patient is slipping from this life and is no longer alert I would think turning up the o2 would not be necessary.

In the weeks and days prior to death, they absolutely whatever makes the patient comfortable. Also, I would think as anxiety and discomfort occur, the meds should be adjusted as well.

nurse62 · Dec 17, 2003

Wait until the doctor says, "Well, why are you doing sats, the patient is hospice?" The last times I worked with this patient she was sitting along bedside feeding herself and doing well, so why wouldn't I do sats when I walked in and found her totally lethargic. And once I requested Roxanol sublinqual for hospice patient very near death and the doctor stated, "no, that will only expedite the process" So go figure.

TiffyRN, BSN, PhD · Dec 17, 2003

I haven't worked hospice but have had many nurse friends who have. My understanding of how to deal with respiratory issues at the end of life is to relieve anxiety of dyspnea and that's about it. If it is truly a hospice patient who is actively dying. . . Turn off the monitors, given them Ativan or Morphine for dyspnea, give them Scopalamine patches for excessive secretions that might tempt some to suction them. Make them comfortable. Think about it, eventually if the dying process completes as it will then those O2 sats WILL drop and no amount of supplemental oxygen will fix that.

MikeLPN · Dec 22, 2003

The way I try to work it is to examine the quality of respirations. If SpO2 is in the toilet but breaths are even and not gasping and they seem peaceful then maybe they don't need it but if they show even a little extra breathing effort or discomfort then I put O2 on and titrate to comfort as well as MSO4 and Ativan the same way. If you turn O2 up and SpO2 just won't come up or gets worse or goes sideways well, I don't know, I just leave it alone at a low level then just to cover all the bases always while keeping the family informed. I just hate the feeling that I'm just prolonging it but I also figure that the more peaceful you are at the end the better you and everyone else can let go and start going through the stages.

LilgirlRN, ADN, RN · Dec 22, 2003

Yeah I was wondering why sats were being monitored too. I would think that if the patient weren't struggling, that CO2 narcosis would be a good thing. If I were the patient, I would just want to be comfortable, if it took O2 to make me that way, give it to me.

ktwlpn, LPN · Dec 24, 2003

Originally posted by MarcusKspn
Hi guys,

I have a questions for you. We had a patient pass away yesterday. He was on hospice for the last 2 weeks. A couple days ago his SaO2 was dropping and we were asking if we can turn his oxygen up to 4L/m (He was running 3). They said they don't really like doing that because it only prolongs dying. They also talked about turning the O2 of completely. I always thought Oxygen would be a comfort measure, to relieve anxiety from hypoxia. Is there new research saying otherwise? Let me know if you know anything.

My thing is-no sats,no vital signs,no nothing while a patient is actively dying.I feel that you want to keep the person as comfortable as you can and as non-invasively as possible...No rectal temps,no IM's if possible.......I don't really believe that a little o2 will keep a dying patient hanging on-if it seems to comfort the patient then apply it....If the cannula or mask bothers them then remove it....I don't like to threat the patient because the family thinks we should-that's when education becomes so vital...Treat the sx of anxiety-with meds,provide comfort measures such as good mouth care and skin care and hold a hand when you can...I will check the b/p to report to the family so they can decide if they should come in or go to work(seriously)But I never give any guarantees...

Bambi25 · Jan 23, 2008

I have a question for all you nurses out there. I am currently dealing with a legal issue at my place of work. We currently had a patient die and the family is now questioning a LPN at my place of work wondering is she may have overdosed a patient on Roxanol. Since I am pretty much almost done with nursing school and I want to continue my education afterwards, I was really nervous to say a statement this nurse said that night. Since we are all professionals and you could give me good feedback, this particular nurse stated to me and another employee there that if we placed this patient on her left side, she would pass away a lot quicker. I did not think that placing someone on their left side would make them pass faster but was I right to tell the appropriate people about the comment that was made or was it wrong for me to "open up another can of worms" since we did not put her on her left side and I knew that this action would not make her pass more quickly. Please give me some advice.

ZippyGBR, BSN, RN · Jan 23, 2008

I haven't worked hospice but have had many nurse friends who have. My understanding of how to deal with respiratory issues at the end of life is to relieve anxiety of dyspnea and that's about it. If it is truly a hospice patient who is actively dying. . . Turn off the monitors, given them Ativan or Morphine for dyspnea, give them Scopalamine patches for excessive secretions that might tempt some to suction them. Make them comfortable. Think about it, eventually if the dying process completes as it will then those O2 sats WILL drop and no amount of supplemental oxygen will fix that.

spot on - this isn't necessarily 'hospice' stuff , just sensible care of someone in the termainl phase or an illness, even though i work on an acute assessment unit in a acute generaland specialist hospital we have qualms aobut this sort of thing or getting syringe drivers organised ... ( due to geography factorsi nthe hospital we have a disporoprionate number of the very few single rooms inthe hospital - but that will change when we get our nice new hospital which is 50 % single rooms and the remaining areas 4 bedded bays )