O2 percentages and liters

[smartnurse1982]

Ok,please help me with this,as I feel like an idiot,and of course,none of the 5 nursing supervisors know nothing,I kid you not? Nobody could answer this question at my office.

I have a pt who wears a trach collar at night. Her orders state"pt may have up to 10L o2 to keep sats greater than 93%. She usually needs some o2 at night,but this is where confusion comes in.

Here is the strange part: On top of the humidifier cup,there are percentages of o2.

It can be turned to 21%,28%,40%,60%,80%,and 100%. On the flow sheets,we have nurses who put down she is receiving 1L of 02,and others put down 8L,and it differs night to night.

What I guessing is that the ones who put down 2L/min are turning the dial to 100% 02,and the ones like me who use 6L are leaving the dial at 40%.

I have never seen a cup like that before,as usually the humidifier cup doesn't have that on it.

Now,we know we can manipulate it to be put at 28%,40%,and so on so that she recieves more or less of the mist. I don't think any of the other nurses understand either,to be honest,because I left notes for them,and nobody responded back.

Nursing supervisor states just put the Liters down instead of Fio2...

So,child is recieveing 1L/min one night for 8hrs,and 8L/min for 8 hrs the next night.

I wonder how we would explain that to the insurance company when they review the notes.

[caliotter3]

The order is sufficient but common sense tells you that you need to concentrate on the O2 sat measurement and adjust accordingly. Keep the O2 as low as possible to maintain 93%. I was told the humidifier cap should remain at 21% .

[smartnurse1982]

Yes,common sense does tell you to adjust 02 to keep sats above 93%.

However,the order isn't sufficient.

If we kept the humidifier cap at 21%,this child would need at least 10L.

Plus,21% is room air. That's the confusing part to me.

[smartnurse1982]

I've learned for evey liter of 02,the % of Fi02 increases by 4%.

So 2liters is 28%,3liters is 32 %,4 liters is 36%

[Not_A_Hat_Person, RN]

I keep the cup at 100%, and adjust the O2 flow rate.

[caliotter3]

Then somebody told me wrong. Wonder why I never had to adjust anything. I was responding to the statements in your post that said each nurse was doing something different. That indicates to me that something isn't right.

[Gemi523]

Any patient with a trach collar should have a humidifier. Humidifiers come with the Fi02% dials. In my opinion, the order was written inappropriately and the charting is messed up. really scary to have nurses charting things they have no idea about.

A patient is on a high flow device. i.e. trach collar. In order to use a trach collar appropriately, the FLOW RATE must be set at 10-12LPM. THIS DOES NOT MEAN the patient receives 10L of oxygen. This is where the dial comes on. You adjust the dial percentage to a patient saturation to maintain 93% as written. That is why you get here more "noise" as you turn the dial to a lower flow. Because more air is escaping into the atmosphere. The higher you turn up the dial, you hear less "noise" because all the oxygen is being delivered to the patient through the trach collar.

The order should had been written, adjust trach collar Fi02 up to 60% to maintain sats greater than 93%. 10L of oxygen delivered from a simple face mask or high flow cannula is approximately 60% Fio2.

Its almost unnecessary to even chart the flow rate of 6L. If the trach collar is used appropriately, it should ALWAYS be at a flow rate greater than 10L. Thats a given. The only thing you should really be charting is the fi02. By charting 6L at 40%, you aren't using the trach collar appropriately. So you really don't know how much oxygen the patient is REALLY getting.

Im an icu nurse x 8 years. I know this. Or ask a respiratory therapist.

[Gemi523]

BTW- smartnurse1982, good for you for asking, at least. Keep doing that. Its for the safety of your patients, and the betterment of your own nursing experience and judgement.

[smartnurse1982]

Wow,thanks Gemi.

Yes,its scary that those higher up aren't even training us right!

Esp the nursing supervisors with Master's in Nursing! YIKES!

[smartnurse1982]

Oh btw,we aren't charting Fi02 at all; we just chart the 02 flow rate.

[classicdame, MSN, EdD]

there appears to be a knowledge gap in your facility that is creating a great learning opportunity. I recommend contacting your Educator and ask for Respiratory Therapy to give in-services about this situation. I find there is a lot of mis-information among nurses regarding RT issues. Good luck!

[nurseprnRN, BSN, RN]

Wow,thanks Gemi.

Yes,its scary that those higher up aren't even training us right!

Esp the nursing supervisors with Master's in Nursing! YIKES!

You know, I have an MN and I don't know everything. If theirs are in, say, administration, there's no reason to expect they would know this. But they ought to be able to say, "Here's the contact information for our RT vendor. Call them and find out, and let us all know what they say."