Non-rebreather mask with a co2 retainer

[Debra,RN]

Would you use a non- rebreather mask for a person who's max o2 is 1.5 lL because of co2retention if there sats drop into the 80's? What would be the most appropriate thing to do?

[vampiregirl, BSN, RN]

Not sure what setting the OP works in, I'm in LTC/SNF.

The sats are just one piece to the puzzle. After completing a more complete assessment I would (quickly) consider my options and obtain/implement the appropriate orders. Things like level of consciousness, skin color, and the rest of vitals would be some biggest deciding factors. Some times cold fingers really affect the SpO2 readings. Positioning and if the resident is able to be instructed in diaphragmatic breathing are usually 2 of my initial interventions with low SpO2.

Just because someone is a CO2 retainer does not rule out ever administering high flow O2 via non-breather in an emergent situation. Respiratory drive can be addressed a little later, but permanent damage due to hypoxia cannot be reversed.

[akulahawkRN, ADN, RN, EMT-P]

One of the things to consider is the patient's SpO2 trend. Just because the Sat's in the 80's doesn't mean the patient is suddenly and horribly hypoxic. That being said, in an emergent situation, there's usually no reason to withhold a high concentration of oxygen from the patient to bring them back to their normal oxygenation. You will probably have to deal with their respiratory drive issues later, but in the immediate moment... putting the patient on a non-rebreather may be completely indicated.

The fact that a patient is a CO2 retainer doesn't mean necessarily that the patient is purely on oxygen drive for breathing. It means that the patient's body is likely used to having a higher CO2 level but may still be triggered to breathe by CO2. Regardless, keep a BVM handy.

[nurseprnRN, BSN, RN]

A saturation of 80 is not the same as a PaO2 of 80, although you might be astonished at how many people think it is. Someone with a sat of 80 has a PaO2 of about ...50. This is not going to be compatible with life for long, even in people with longstanding hypoxia.

[Do-over, ASN, RN]

Personally, I would err on the side of oxygen. There is a reason we keep BVMs at the bedside.

However - you said 80s. So, 88-89? Or 80? 81? Depends on the patient, the trends. Check the patient, check the equipment.