Its been one of those weekends...

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Specializes in School LVN, Peds HH.

I have been an LVN for almost 2 years now. And this weekend made me feel like I know nothing!

I work in home health. The case I have isn't that complicated, and is generally pretty easy and its peds, which makes it more enjoyable for me. However, this weekend my patient decided to give me a couple scares. Last night with his O2 sats -- he kept dropping for no reason at all. And ended up taking double the amount of O2 than he usually uses. And then there's tonight... his O2 ran out.

Now, when I was in school, we were barely given instruction on how to work O2 tanks. But its easy to pick up. This patient has liquid oxygen, something I'm not used to, nor have I been properly trained on it. His tank is always full when I come on. I never have to worry about running out. Tonight was ridiculous though. When I came on, his mom still had him on his portable tank. I looked at the big one, and it was basically empty. I asked her if she thought it would last thru the night, and she said if it didn't to hook the tubing back up to the big one. Then she made it sound like the spare tank in the other room wasn't working properly... So, 3am rolls around and his portable runs out, just in time for his breathing tx. I try and hook it up to the big tank, and nothing. I can't even get it to turn on. Meantime, my patients sats are slowly dropping. I hook him back up to the portable, and luckily it had a little left in it. My options are limited here... Call the RN case manager and wake her up -- however, if I do that I run the risk of his sats dropping too low while she explains to me what to do. Or, wake up the parents who are in the house and know what to do right now and keep his sats from going too low. I chose the latter. In my mind it makes more sense to put the patients safety first, right? Anyway, apparently the tank in the other room works fine. Mom just grabbed it and hooked it up. Making me feel stupid and incompetent. Plus, it doesn't help that when I went thru orientation the nurse orientating me didn't show me how to use these kinds of tanks. It made me feel a little better when the dad came back in and was upset that the tank that was empty wasn't switched out before the night started.

I like my job. It has its flaws, but its good for me right now. I now know what to do if this happens again, but I hate that I didn't know what to do to begin with. I know I can't be the only nurse this has happened to. Gah! Does it ever get easier?

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Specializes in Adolescent Psych, PICU.

My first question would be why is your pt on O2? That might help figure out why his sats were dropping. I worked PICU for 2 years. What are your pt's normal sats and what were they dropping too? Any cardiac hx? Fever? Was his resp rate increased?

Did you try (not sure what supplies you have): suctioning, repositioning, was the patient actually symptomatic? Chest pt, getting a new pulse ox or putting it on a different site, have the pt cough (if he/she can), was there any upper resp issues like a cold or congestion?

I just got off work but I those are my thoughts real quick. Good luck, dont beat yourself up over it, the more experiences (good and bad) you have (and we all have good and BAD) the better nurse you will be in the long run! And you did the right thing, if you dont know you ask someone!

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I guess the takeaway lesson from what you went through is to never take assignment unless you feel comfortable using all the equipment. Also, perhaps to be more assertive next time in resolving an issue before it becomes an actual problem......maybe to have asked mom to show you how to hook up the spare tank from the other room before they settled down for the night. Hindsight is 20/20, of course. :)

Nursing can be pretty technical at times. I'm the type of person that has to do things a few times before I am proficient at it, so it can be frustrating. But your patient was ok and I think you did the right thing in waking up the parents; after all, you showed that their child's safety was most the most important thing to you.

I'd try to flush it for now and just learn and go on. You obviously are trying to be great at what you do, and I'm guessing you are already great at many things. :)

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Specializes in School LVN, Peds HH.
My first question would be why is your pt on O2? That might help figure out why his sats were dropping. I worked PICU for 2 years. What are your pt's normal sats and what were they dropping too? Any cardiac hx? Fever? Was his resp rate increased?

Did you try (not sure what supplies you have): suctioning, repositioning, was the patient actually symptomatic? Chest pt, getting a new pulse ox or putting it on a different site, have the pt cough (if he/she can), was there any upper resp issues like a cold or congestion?

I just got off work but I those are my thoughts real quick. Good luck, dont beat yourself up over it, the more experiences (good and bad) you have (and we all have good and BAD) the better nurse you will be in the long run! And you did the right thing, if you dont know you ask someone!

He's on continuous O2... lots of respiratory problems. His normal sats range in the 97-100%'s. That night he kept dropping to 94-95%. The strange thing was he wasn't symptomatic, suctioning didn't help raise it, I got a new pulse ox and switched the site, repositioning didn't do anything either... He was back to 0.5lpm tonight. So, I have no idea why Friday night was different.

I guess the takeaway lesson from what you went through is to never take assignment unless you feel comfortable using all the equipment. Also, perhaps to be more assertive next time in resolving an issue before it becomes an actual problem......maybe to have asked mom to show you how to hook up the spare tank from the other room before they settled down for the night. Hindsight is 20/20, of course.

Nursing can be pretty technical at times. I'm the type of person that has to do things a few times before I am proficient at it, so it can be frustrating. But your patient was ok and I think you did the right thing in waking up the parents; after all, you showed that their child's safety was most the most important thing to you.

I'd try to flush it for now and just learn and go on. You obviously are trying to be great at what you do, and I'm guessing you are already great at many things.

Haha yeah, never again will I take an assignment without knowing all the equipment! I thought I could learn as I went, but when 3am comes and I don't know what to do, I'm screwed.

Thanks for saying I did the right thing! I know this is most definitely a learning experience. I just want to make sure I don't mess up too badly as I learn :)

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Specializes in LTC, Subacute Rehab.

My first thought is to wonder why you were so worried about an oxygen saturation of 95%. I don't wish to be antagonistic, but I am curious :cool:

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Specializes in School LVN, Peds HH.
My first thought is to wonder why you were so worried about an oxygen saturation of 95%. I don't wish to be antagonistic but I am curious :cool:[/quote']

His alarms start going off at 93%. So for him to be at 95% is him in the middle of a downward trend. Chances are, if he's hanging out around 95%, he'll be below that soon enough.

Plus, this is also a personal preference, I try to maintain my patients levels @ 97% or above. Keeps me feeling safe about where they're at.

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My first thought is to wonder why you were so worried about an oxygen saturation of 95%. I don't wish to be antagonistic but I am curious :cool:[/quote']

I do mostly respiratory peds. First thing ever with a mild desat (and like Sara, I wouldn't even worry about 95% while asleep, healthy kids drop lower than that asleep) is reposition. And I take that back, that would be second, first would be to troubleshoot the probe.

However, I've had to give this explanation to parents in the hospital who during the night had a nurse that appeared to them to be freaked out by mild desats, and then day shift nurses and respiratory therapists come in, and by the numbers, day shift tends to have more experience, just because we've done our time and gotten days if we wanted it. So I walk into the room with an experienced RT, and we're very "meh, it's ok" about whatever the night shift thought was bad. I've got experience, so I know if things get worse, I know that I can quickly do what's needed, so I can handle being more aggressive about weaning oxygen or trying to stay off oxygen/more oxygen than someone that isn't as confident in what they know as I am. I can be more "wait and see" than others because I know after the wait, if I don't like what I see, I'm not over my head, where I know even just a couple years ago, I'd have felt overwhelmed. And then what I think really pertains to someone in home health, during the day in the hospital, I know I have more resources available to me if things go bad than someone working at night. Just by virtue of more people being there. And well, I definitely know I've got more resources than someone working home health. So I can see where something that I think is a total non-issue at the moment would be enough to make someone out at a house with no real backup be more aggressive treatment wise than I think necessary.

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Specializes in LTC, Subacute Rehab.
His alarms start going off at 93%. So for him to be at 95% is him in the middle of a downward trend. Chances are, if he's hanging out around 95%, he'll be below that soon enough.

Plus, this is also a personal preference, I try to maintain my patients levels @ 97% or above. Keeps me feeling safe about where they're at.

That makes decent sense. I'm used to COPDers - "91% on 2L? Fine!"

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That makes decent sense. I'm used to COPDers - "91% on 2L? Fine!"

I'm used to kids coming up from the ER on 50% venti mask, after all, on room air, they were only 95%. :) I get them weaned to room air within an hour, of course, then they're only at 92%, but as I end up telling their parents, they aren't working, they aren't blue, all is good. :)

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Specializes in School LVN, Peds HH.

I just reread all you guy's advice tonight. I'm having issues with the kid.... again! This time he's been alarming all night. He was fine and at 100% on 0.5L, then out of nowhere he dropped to 89%. I finally got him stable at 97-98% on 1L, but man, I'm a wreck! I find myself doing nothing but watching the monitor. Its shifts like this that make me feel not cut out for nursing.

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Have you tried repositioning before upping the O2? And how long does she stay at 89%? Transient dips to the high 80s are pretty normal.

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Specializes in School LVN, Peds HH.
Have you tried repositioning before upping the O2? And how long does she stay at 89%? Transient dips to the high 80s are pretty normal.

The first thing I do is check the probe. Second is reposition. Third is suction if needed. Forth is upping o2.

He has his transient dips nightly, but never goes lower than 97 on a good night. He was down in the 80's for minutes the last two nights in a row. But last night was because his o2 ran out, and he was on RA. The tank said he had 1/4 left. It lied to me.

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