Oxygen dependant patients

Trauma Columnist · Aug 30, 2009

At all the units where I see pts, the units provide oxygen for the oxygen-dependent patients. To say that the pt has to go 4-8 hours on their own supply is too risky: what if they run out, what if there is an emergency and you need to increase their oxygen? Nope - too risky.

CocoaGirl · Aug 30, 2009

I agree with you TraumaRus, a portable O2 tank will not last that long & the patient will run out. This is the issue we are dealing with in the clinics, who is going to be held liable if something happens? Can the non-medical area mgr who is making this decision be held responsible (which I doubt)or will it fall on the RN? I plan to discuss this with our medical director. I am really upset by this, the patients who need the oxygen are our most fragile and elderly ones. I can't even imagine them trying to bring enough oxygen to last 5-6 hours. The small tank they bring now are about enough to last for the trip to & from dialysis.

workingmomRN · Aug 30, 2009

As a medical facility, the dialysis clinic is responsible to provide O2 if the patients need it. Our clinic recently ordered 2 additional oxygen concentrators because we are getting more patients who are dependent on O2. We had one little man who had to have 6L/min so we had to use 2 concentrators for him each treatment. The NH was kind enough to send us a T-type tubing that could be connected to both concentrators & then to the nasal cannula. Eventually, he has gotten down to 3L now, and has a little portable tank with him when he comes, but it wouldn't last anytime at all. I would really be afraid of the liability of not providing O2 for patients.

Trauma Columnist · Aug 31, 2009

ANother thing to consider: if the pt is on hi-flow oxygen, they need moisture!

Lacie, BSN, RN · Aug 31, 2009

All the clinics I have worked in required pts to bring thier own O2. If one tank wasnt enough then they were informed to bring 2. The most recent clinic I was associated with didnt have concentrators as they only utilize tanks and use it as "billable" I believe. We kept 4 tanks for emergency use only although too many visitor patients using O2 and many didnt bring 2 tanks or we knew wouldnt have enough for thier trip home after treatment resulting in those tanks being quicky depleted. Became a real issue for me as ours wasnt delivered and our biomed/chief tech would have to make a trip 25 miles away to refill tanks. We use to have one concentrator that was a rental but the administrator said it was too costly. Most of the RN's would forget to document the o2/cannulas into the med listing at end of shift or forget to inform the chief tech we were low resulting in many times retrieving an "empty tank". Most new patients new to dialysis think like hospitals we have the o2 units at the chairside in the walls.

81Bubbles, BSN, RN · Aug 31, 2009

So all of your O2 concentrators are being used @ the same time. That alone is risky what if someone else needs it. I know you have emergency O2 on the code cart. Still risky though.

Do you have multiple shifts where management could space out these O2 dependant patients? I know where I work we have pateints that are PRN O2 users and their needs often pop up out of no where. We actually have I believe 7 concentrators for a 24 chair facility. And sometimes that isn't really enough.

O2 concetrators and cannula add up expense wise. Part of the problem managemet has is Dialysis units are usually for profit and many of us as nurses are not focused on this at all. We forget to bill @ EVERY tx for the cannula and O2. I think it's crazy the way this works but it's a big part of the problem.

Trauma Columnist · Sep 2, 2009

There is huge liability in not being able to provide oxygen for those that need it. And...what do you do in a code situation? BVM minus oxygen? Thats not the standard of care.

Lacie, BSN, RN · Sep 2, 2009

I had gone round and round with the administrator over this very issue among many other safety/pt care issues. We kept one tank (we did not have concentrators at all only tanks) on the crash cart. There have been times it was reported to me the crash cart tank had to be used or o2 removed from someone with what they called "temporary" sob to put on another pt. Coming from my open heart and critical care background I couldnt even fathom these issues being a "problem". I couldnt get the company to rectify anything so needless to say I have since left. But even though it's not my problem anymore some of my former staff still keep close contact with me and tell me the issues are even more pravalent now with the cuts and the new manager is more of the so called yes person. She came from an acute setting with 1 year experience, never worked a chronic unit and is now the manager of the chronic unit..eekkkk. They tell me the things going on now I would have had thier heads for LOL. State came in due to pt complaints but I guess they still managed to keep thier heads above water and get by them. Dont understand how but they did. I know of one specific incident while I was manager on my day off the charge RN coded a 44 year old patient and no one even took out the ambu bag nor gave any ventilation!!! I tried having mock codes and they wouldnt alot me the extra time for staff to be paid to do them. It all comes down to cost.

nursewratchet59 · Sep 2, 2009

The State won't give a crap about the budget, if something happens and there is no O2 in place. Your liscense, the facility liscense, and possibly Medicare funding for the facility. Speak to the Medical director for another concentrator.

Lacie, BSN, RN · Sep 3, 2009

The State won't give a crap about the budget, if something happens and there is no O2 in place. Your liscense, the facility liscense, and possibly Medicare funding for the facility. Speak to the Medical director for another concentrator.

The medical director wasnt any help either (been there done that). He is a great doc and pts/staff love him but when it comes to the company...well that's another story. I am no longer with that clinic as the manager. When I spoke to the medical director his exact words regarding my administrator was "she's a liar and a witch. She was ran too many of good nurse off" yet he doesnt intervene. Shame as my mother is also one of his patients and we love him but if she ever needed dialysis well I would fight for home treatment as between the choices of this clinic and the local Davitas here.......lot to be desired. I've worked for both and finally decided just to get out of dialysis. I couldnt get them to get 1 concentrator to replace tanks much less anything else extra. Again we had no contrentrators only tanks as the company felt the rental was too expensive lol.

soulofme · Sep 3, 2009

We encourage our pts to bring their own, which they do. We have about 12 tanks on our unit and do checks on the ones set up to go..every day. Im a fanatic about this.