How much oxygen can a nurse give to infants, if they are in need?

Jolie, BSN · Sep 12, 2012

Here in the U.S., oxygen is considered a drug, and a nurse needs an order (or standing order or policy/procedure) to administer it on an emergency basis to any patient, until a physician or other authorized prescriber (such as an advanced practice nurse) can be reached.

Most hospitals in the U.S. that provide labor and delivery services have staff members trained in the Neonatal Resuscitation Program, which teaches an algorhythm for the immediate management of infants in the delivery room. This training is then written into standing orders or unit policy and procedure so that nurses or respiratory therapists have written guidelines to "cover" their administration of oxygen (and possibly other emergency medications) in the first few moments of a newborn's life.

As for the newborn nursery, pediatric unit and ER, standing orders or policies and procedures guide the nurse's immediate management of a child's oxygen needs until a prescriber is reached for orders specific to the child.

As for the amount of oxygen delivered, it depends upon the situation. We use monitors to guide our administration of oxygen so that the patient is not over, or under oxygenated. Rather than limiting oxygen to a set concentration or flow, it is likely that a standing order would read something like this, "May administer oxygen by hood, mask, or nasal cannula as needed to maintain oxygen saturation 92-95%."

TiffyRN, BSN, PhD · Sep 12, 2012

Jolie's answer seems very in line with what I've seen. I renewed my NRP (Neonatal Resuscitation Program) card a few months ago and the biggest change this last time was adding pulse oximetry guidelines to newborn resuscitation. One of the surprising recommendations was that a normally transitioning newborn may take 10 minutes to achieve 90% pre-ductal oxygen saturations. NRP is now recommending most newborn resuscitations be started with 21% oxygen on a blender to meet the minute by minute pre-ductal oxygen saturation guidelines they set.

I do not work in the general nursery but rather in the NICU where we have intense support and can expect an MD or NNP in moments in an emergency. In our general nursery the nurses would administer blow-by from oxygen tubing set at 5-10 liters/minute, maybe blended (but probably not if it wasn't in a delivery situation). Their method of adjusting the "dose" would be to position the oxygen tubing either cupped over the infant's face or progressively further from the infant's mouth/nose to achieve the desired oxygen saturation.

I understand you are in Hungary and each nation probably has their own guiding organization but in the USA we use NRP which is set by the American Academy of Pediatrics (AAP). I will include a link to the article in Pediatrics which outlines the latest NRP resuscitation guidelines including targeted pre-ductal oxygen saturation guidelines.

Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

imaginations · Oct 17, 2012

In our general nursery the nurses would administer blow-by from oxygen tubing set at 5-10 liters/minute, maybe blended (but probably not if it wasn't in a delivery situation). Their method of adjusting the "dose" would be to position the oxygen tubing either cupped over the infant's face or progressively further from the infant's mouth/nose to achieve the desired oxygen saturation.

What you describe as moving the tubing further from the baby's nose or mouth to achieve a desired Sp02 we call 'blow over' and is firmly not allowed in our hospital policy, as you can't actually measure accurately how much oxygen you are delivering and a child is receiving.

We give as much oxygen as required to maintain adequate saturations. Obviously an increasing oxygen requirement is a red flag that requires medical review. As in the US, in Australia oxygen is also technically considered a drug, though I've never seen an order charted.