I think I made a boo-boo...

eatmysoxRN, ASN, RN · Aug 24, 2012

I probably would have never taken off the venturi in the first place. I would have gotten a BSC and done it that way. I'm no expert whatsoever, but I thought venturi masks gave a specific amount of oxygen? And another thing is that I didn't know that cannulas could handle such a high flow.

I'm interested to see responses to this too. The above is just how I would have handled it, and isn't necessarily the correct or best way.

MeganNCA · Aug 24, 2012

Thanks for the response. Like I said, the nurse acted like it was no big deal - "everyone makes mistakes." But the worst possible thoughts came running through my head; for a split second I thought I could have given her oxygen toxicity. Then I realized that was pretty farfetched - the patient was lucid and could have easily removed the cannula. I feel like I'm tripping over my own feet all the time - I'm new to the hospital work environment and a very young nursing student. I know you have to make mistakes in order to learn but a hospital is a very dangerous place to make them! The joys of being a nurse, I suppose.

sharpeimom · Aug 24, 2012

Calm down! You didn't harm the pt. or make her worse. It sounds as though she was able to remove

her cannula if it had burned a lot. You didn't say she loosened or removed it. I probably would have

put her on a BSC instead but now you know to think of that the next time.

You're a student, and as such, are still learning both facts and how to apply common sense and nursing

assessment. Unfortunately, it doesn't come all at once. I'll bet you'll never do that again! My grandma

used to say that if we learned something from our mistakes, then they became teaching moments instead. Good

thought!

allnurses Guide · Aug 24, 2012

This was a potentially dangerous one disguised as a simple mistake. Did someone explain to you why (in addition to the pain/drying of the NC) this might be a problem?

NC's max out at 6L (hi-flo NC can do a bit more) and Venutri masks at 15L. The major problem here is that NCs deliver 25-50% oxygen yielding a max of 3L if you do the math; Venturi masks deliver 100%. Basically this woman was getting 3L instead of 15L.

LadyinScrubs, ASN, RN · Aug 24, 2012

We learn by our mistakes--and you and your patient escaped a bad outcome based solely from your actions. You are in your 3rd semester of NS, and it is time to learn why O2 is delivered to a pt as well as the difference between O2 delivery systems.

Another thing that you need to brush up on is: you noted a problem with the patient--nose burning while on the mask -- and the pt stating that she wanted the O2 turned down. Both of these situations should have caused you to report the info to the nurse so she could have checked on the patient. It is fortunate you had a good relationship with the nurse and she was understanding. Others would have written you up and filled out an incident report.

It is critical that you understand your scope of practice--what you can do and cannot do.

Esme12, ASN, BSN, RN · Aug 24, 2012

This was a potentially dangerous one disguised as a simple mistake. Did someone explain to you why (in addition to the pain/drying of the NC) this might be a problem?
NC's max out at 6L (hi-flo NC can do a bit more) and Venturi masks at 15L. The major problem here is that NCs deliver 25-50% oxygen yielding a max of 3L if you do the math; Venturi masks deliver 100%. Basically this woman was getting 3L instead of 15L.

A venturi/venturi mask will not deliver high flow O2 and will not deliver 100%O2. The issue is that the patient needed a specific O2 flow which is why the Venturi mask was ordered. If the patient was a CO2 retainer this could have presented a problem. OR if the patient was very O2 sensitive and needed that specific flow O2 to maintain blood saturation and prevent hypoxia it would have presented a problem.

OP we all make mistakes......and that is OK as long as we learn from them. I also probably would have had the patient use the BSC and I might ask a patient "Is this usual for you?" But I verify the answers before I listen to their advice.

http://www.dmacc.edu/instructors/kegeorge/prac5/matrixII.htm

Low flow Oxygen delivery devices

Nasal cannula: Two short plastic nasal prongs and Delivers 25-45% FIO2 at 1-6 L/min flow.

1) Flow 0 liters per minute: 21% (Room Air)

2) Flow 1 liters per minute: 25%

3) Flow 2 liters per minute: 29%

4) Flow 3 liters per minute: 33%

5) Flow 4 liters per minute: 37%

6) Flow 5 liters per minute: 41%

7) Flow 6 liters per minute: 45%

8) Flow rates >4 liters per minute irritates nasopharynx

Simple Oxygen Mask: Delivers 35-60% Oxygen at 6-10 L/min flow rates. Room air entrained during inspiration

Moderate flow oxygen delivery devices

Partial Rebreathing Mask with reservoir: Delivers 35-60% Oxygen at 6-10 L/min flow rate

-First third of exhaled gases mix with reservoir

-Exhaled gases from upper airway are oxygen rich

Venturi Mask

a) Allows provider to dial in oxygen concentration

b) Delivers 25-60% oxygen at 4-8 L/min flow rate

High oxygen delivery devices

Non-Rebreathing Mask with reservoir: Delivers 95% Oxygen at 10-12 L/min

The two flutter valves added to rebreathing mask prevents:

-Entrainment of room air during inspiration

-Retention of exhaled gases during expiration

Oxygen Hood: for infants: Clear plastic shell encompasses the baby's head

Size of hood limits use to younger than age 1 year

Allows easy access to chest, trunk, and extremities

Allows control of Oxygen Delivery

-Oxygen concentration

-Inspired oxygen temperature and humidity

Delivers 80-90% oxygen at 10-15 liter per minute

http://webhome.broward.edu/~gbrickma/Forms/Oxygen%20Delivery%20SystemsPP7.pdf

The venturi mask, also known as an air-entrainment mask (and sometimes by the brand name Venturi Mask®), delivers a known oxygen concentration to patients on controlled oxygen therapy.

Venturi masks are considered high-flow oxygen therapy devices. This is because venturi masks are able to provide total inspiratory flow at a specified FIO2 to patients therapy. The kits usually include multiple jets in order to set the desired FIO2 which are usually color coded.

The color of the device reflects the delivered oxygen concentration and.....

The color however varies with different brands and the user must check the instructions to determine the correct color for the desired FIO2.

GOod luck in school!

allnurses Guide · Aug 24, 2012

Very astutely corrected my grossly poor (incorrect) wording, evidence of the fact it's been a while since I was a staff nurse. Just ignore me. It's amazing what google will do for making you look smart, or if you don't, stupid. :)

Esme12, ASN, BSN, RN · Aug 24, 2012

No kidding right? Google is my friend.......I use it to give reference to my 35 years of critical care nursing expereince.

allnurses Guide · Aug 24, 2012

Should be the main message of school: use everything you have access to.

ENicuRN · Aug 24, 2012

We are all human and Mistakes happen, but thank goodness your patient was not harmed.

Just be sure to:

1) Always know AND practice within your scope of practice!

2) if you don't know about a certain device, procedure, medication, please please please don't use it or give the med without looking it up and consulting another nurse.

It is really scary when people just assume " it's okay" when it is far from it.

3) Acknowledge your mistake, be honest about it, and learn from it!

Ruby Vee, BSN · Aug 24, 2012

Hi all, This is my first post on allnurses.com!
I'm a nursing student in my third semester of clinical and I work as a CNA on a pulmonary medical/surgical floor. I really like my job, but last night at work I think I made a mistake.
I had a patient whom I was assisting onto the commode, and her venturi mask (set at 15 liters) wouldn't reach. She asked me if I would give her the cannula instead. So I unplugged the venturi and replaced it with the cannula. She then asked me to turn down the oxygen flow, as it was burning her nose.
Mind you, I had no idea that venturi masks normally have a much higher flow rate. I asked her what she would like it set at, she told me, "ten." I then left her on the commode and gave her the call light so she could get a hold of me when she was through.
One of my other patients was calling out for help, so I went to see what he needed. In the meantime, apparently she used her call light to ask for the nurse and was complaining about the oxygen burning her nose because the flow rate was too high.
The nurse called the respiratory therapist, and she figured out what the problem was and fixed it. The patient was rather distraught. I was in that other room cleaning up my patient who had a rather large bowel movement in the bed. The nurse then came in to do a dressing change on this man and explained to me what happened.
My stomach instantly dropped. This nurse just happens to be one of my favorites to work with and assured me that it was just a mistake, and that these things happen, but I can't seem to stop thinking about it. Has anyone else ever made this mistake?

Everyone makes mistakes, and I'm sure you won't make this one again! Yes, it could have had some bad consequences for the patient, but it didn't. I don't think I've ever made that particular mistake, but I have made some doozies! (There's a thread about "Mistakes we Have Made" or something to that effect. Do a search for it -- it's worth reading!) The only nurse, physician or CNA who claims they've never made a mistake is either lying or too stupid to realize they've made one!

When you make a mistake, admit to it just as soon as you've realized it and set about to mitigate the damage. Patients are for the most parts hardy sorts, and they'll survive some pretty scary mistakes as long as you don't try to cover it up. You're going to be a nurse, you WILL make mistakes. Count on it. What matters most is that you learn from them and that you handle them with honor. Based on your account, I don't have any fear that you won't do the right thing.