Part of our floor is COVID med-surg. When we first opened we were told patients had to be stable on 6L or less per nasal cannula for at least 2 hours before they could come. Last week it changed to 10L or less NC or simple mask. Today they sent us a patient on an oxymizer, technically it was less then 10L, but even if it is less than 10 don't they produce higher FIO2? House Sup. said to take patient we're guessing pt was the most stable in the ICU.
Do you have guidelines as to who is med-surg vs imc/ICU? Are they continually changing? Do your physicians write specific O2 orders? Our doctors usually write an order at the beginning of stay, but some patients quickly exceed it.
Any resources on knowing how/when to go between different oxygen devices- nasal cannula, simple mask, non-rebreather, oxymizer? Need a refresher on this "middle ground".
Specializes in New Critical care NP, Critical care, Med-surg, LTC.
Same as many places we were intubating anyone needing more than 5-6 liters in the Spring. When I left Saturday morning we were out of Vapotherms in our hospital (company name for our high flow), we can use our Draeger vents as high flow, that's usually for people after they were extubated.
We only have 12 bed in our ICU. Eight were COVID Saturday morning. Currently our stepdown unit doesn't take COVID patients, so they have to be stable enough for the COVID unit med-surg floor. They will graduate people up to high flow and keep them on the med-surg unit, but they're not likely to downgrade an ICU patient to that floor still needing high flow.
However, our med-surg unit has remote telemetry and continuous pulse ox monitoring for all COVID patients. Not having them monitored seems crazy since we're finding people can be asymptomatic but hypoxic for long periods of time. Just something bad waiting to happen if they're not being monitored.
I have worked a covid med surg unit for 7 months now. We frequently have patients on specialty nasal cannula up to 15L. We also often have patients on high flow, even maxed out on high flow oxygen at times at 60L and 100%.
We have had patients require a non rebreather on top of the high flow if they were maxed out and desaturating. If proning doesn’t help wean off the non rebreather or their ABG is critical they transfer to the ICU.
We don’t routinely use bipap on these patients but there has been a few times where patients have been ordered bipap, those patients can stay with us two hours (to see if it helps before moving the patient) and after that they are in the ICU.
So essentially our med surg manages patients right up to the point of needing intubation. (We were staffed 1:3 to account for the higher acuity, until this second wave and our current staffing crisis. Now we have our same really sick patients and a 1:5 ratio.)
The progression is regular nasal cannula up to 6L, specialty cannula up to 15 L, then HFNC. We use a non rebreather on any patient for a critical desaturation, in addition to whatever oxygen they were on. Our physician order is always supplemental oxygen to keep SpO2 > 90 (or whatever they chose for that patient) and we use whatever oxygen delivery needed to maintain that— not specially ordered as such.
JBMmom, MSN, NP
4 Articles; 2,537 Posts
Same as many places we were intubating anyone needing more than 5-6 liters in the Spring. When I left Saturday morning we were out of Vapotherms in our hospital (company name for our high flow), we can use our Draeger vents as high flow, that's usually for people after they were extubated.
We only have 12 bed in our ICU. Eight were COVID Saturday morning. Currently our stepdown unit doesn't take COVID patients, so they have to be stable enough for the COVID unit med-surg floor. They will graduate people up to high flow and keep them on the med-surg unit, but they're not likely to downgrade an ICU patient to that floor still needing high flow.
However, our med-surg unit has remote telemetry and continuous pulse ox monitoring for all COVID patients. Not having them monitored seems crazy since we're finding people can be asymptomatic but hypoxic for long periods of time. Just something bad waiting to happen if they're not being monitored.
MunoRN, very nice explanation!
Good luck Ele_123.