Oxygen and the rebreather mask question

We had a pt with O2 of 90. Hand are warm and this is a hospital grade pulse ox.
Dr says get oxygen and set it at 2 litters. The head managers and other head staff started barking orders too and say he’s on a rebreather not a nasel candela so it should be 10 litters and the bag should blow up.

I don’t now about how many liters I just follow Doctors orders. But I thought the rebreather bag did not have to be full?

anyone want to educate me.

[LovingLife123]

Why were they on a nonrebreather and not a nasal cannula? I’m confused.

[amoLucia]

pOx of 90 is not so bad for everyone.

There's gotta be more clinical info that we just don't have here in this post.

[Wuzzie]

1. A pulse ox reading of 90 does not warrant a non-rebreather mask.

2. When using a non-rebreather O2 flow must be between 10-15 lpm but the bag does not have to be fully inflated.

Edited Jul 18, 2020 by Wuzzie

[JKL33]

Agree...not clear why this patient needs an NRB, period.

[Nurse GreenBean, ASN, RN]

7 hours ago, Slipping CMA said:

We had a pt with O2 of 90. Hand are warm and this is a hospital grade pulse ox.
Dr says get oxygen and set it at 2 litters. The head managers and other head staff started barking orders too and say he’s on a rebreather not a nasel candela so it should be 10 litters and the bag should blow up.

I don’t now about how many liters I just follow Doctors orders. But I thought the rebreather bag did not have to be full?

anyone want to educate me.

Was PO2 low?

(I’m trying to learn more about critical care nursing. Please bear with me ?)

[Slipping CMA]

We aren’t using nasal candula because of covid. Don’t ask me why it was a rule handed down by the higher ups.

as for why the oxygen it was ordered by the doctor because of his o2 level and patient felt dizzy.

[canoehead, BSN, RN]

I would start with nasal cannula at 2lpm and titrate up. The nonrebreather would come after maxing out the prongs, and yes, the bag must be inflated.

[Slipping CMA]

1 hour ago, Nurse GreenBean said:

Was PO2 low?

(I’m trying to learn more about critical care nursing. Please bear with me ?)

I was told anything below 94-93 isn’t a good sign. So 90 was low. But fake nails, nail polish cold hands can affect the O2 reading.

[Nurse GreenBean, ASN, RN]

2 hours ago, Slipping CMA said:

I was told anything below 94-93 isn’t a good sign. So 90 was low. But fake nails, nail polish cold hands can affect the O2 reading

That’s my understanding as well, though usually an NC would be OK for that.

I was asking about the partial O2 blood has because my understanding is that with some Covid patients, their SaO2 can appear to be in normal range but the blood gas PO2 level can be down in the 50s, so I was wondering if that was why an NRBM was being used on someone with 90% SaO2.

keeping in mind blood gasses are new to me and I haven’t looked at them since nursing school, go easy on me ?

[JKL33]

15 hours ago, Slipping CMA said:

We aren’t using nasal candula because of covid. Don’t ask me why it was a rule handed down by the higher ups.

They sound utterly uneducated about what they're doing and need to get with the program. Either that or staff has misunderstood. This is not correct and they can't just make policies to administer unnecessary and incorrect treatment because covid.

13 hours ago, Slipping CMA said:

I was told anything below 94-93 isn’t a good sign.

That's simply not universally true. It all depends on the clinical situation. An SpO2 of 93-94 might be a reasonable (but very general) guideline for when you should report to an RN, but then the RN (and possibly medical provider and/or RRT) will assess the patient to determine the significance of the finding.

[JKL33]

15 hours ago, Slipping CMA said:

We aren’t using nasal candula because of covid. Don’t ask me why it was a rule handed down by the higher ups.

Just for your own info ?, this ^ stemmed from concern about causing viral particles (SARS CoV-2) to be aerosolized (blown out into the air) by "blasting" oxygen into the airways through nasal cannula prongs. To the extent that this is a concern, it refers almost exclusively to high flow nasal cannula, not low flow like we would be talking about with this patient at least initially. Also, patients can wear a simple mask over their face (not an oxygen mask but like a basic surgical mask) while receiving hi or low flow NC oxygen.