peds nurses...what a blow by for o2 delivey?

wooh, BSN, RN · Mar 13, 2006

Blow by isn't done much at my hospital (and by policy isn't done at all.) You have no control over how much O2 the kid is actually getting. (So the 1.5 L order makes me kind of laugh.) Most kids we tape the nasal cannula to them (masks make them more anxious so we avoid them if we can.)

Jolie, BSN · Mar 13, 2006

Check an OB textbook or the NRP materials for more detailed information regarding blow-by 02.

It is administered via face mask held near the baby's face, rather than strapped or held on, which most children will resist. Wooh is correct that it is virtually impossible to measure the actual FiO2 that is administered to the child, especially since he will probably not lay still with his face near the mask. It is my guess that blow-by O2 at only 1.5 lpm probably amounts to only about 24% FiO2.

Also, a child receiving supplemental oxygen needs to be on a pulse-oximeter to assess O2 saturation to determine the effectiveness of treatment.

rn/writer, RN · Mar 13, 2006

Check an OB textbook or the NRP materials for more detailed information regarding blow-by 02.
It is administered via face mask held near the baby's face, rather than strapped or held on, which most children will resist. Wooh is correct that it is virtually impossible to measure the actual FiO2 that is administered to the child, especially since he will probably not lay still with his face near the mask. It is my guess that blow-by O2 at only 1.5 lpm probably amounts to only about 24% FiO2.
Also, a child receiving supplemental oxygen needs to be on a pulse-oximeter to assess O2 saturation to determine the effectiveness of treatment.

I've administered blow-by O2 as an EMT and as a family member. for frightened kids who will arch their backs and try to pull off anything like a mask or a nasal cannula, having mom or someone else hold the mask a little bit off the face is better than nothing. You then monitor the results with PO2 readings. This is best used as a short-term measure for a child who is urgent/emergent but not critical (in which case, they are probably too sick to fight the mask).

I HAVE seen animal masks that some kids don't seem to mind too much used for neb treatments and such. In fact, I know one little boy who, when he has a bad asthma attack and has to go to the ER, asks for a "fishy mask."

At any rate, while blow-by is not the optimal choice, sometimes it is the only workable option. It would be interesting to compare blow-by with a calm child vs mask or n/c with a kid who is anxious/fighting.

rehab nurse · Mar 13, 2006

well, as far as i know, this is a fictious patient. it's made up of information, and we have to be kind of creative in making up a care plan.

but SPO2 was monitored and was always around 93 to 94 on room air (the order was to check in on room air).

anyways, it's required to document the skin integrity thats in contact with any o2 device and tha's why i heeded to know what it is. thanks you guys! i thought it must not be used very often

edit to add: sorry for my bad typos, i'm so very tired and i'm trying to finish up some loose ends.

rn/writer, RN · Mar 13, 2006

well, as far as i know, this is a fictious patient. it's made up of information, and we have to be kind of creative in making up a care plan.
but spo2 was monitored and was always around 93 to 94 on room air (the order was to check in on room air).
anyways, it's required to document the skin integrity thats in contact with any o2 device and tha's why i heeded to know what it is. thanks you guys! i thought it must not be used very often

the salient feature of blow-by o2 is that there is no skin contact with an o2 delivery device. someone holds the mask as close to the child's face as the little one will tolerate, thereby eliminating the concern about mask straps/cannula prongs.

it isn't used very often (or very long). the biggest drawback is the continued need for someone to hold the mask. it's a stop-gap measure for pre-hospital transport or something like a neb treatment that simply won't be tolerated any other way. if a child needs to be on supplemental o2 for any lenth of time, it simply isn't practical.

casualjim · Mar 13, 2006

There is even a company ( I cant' remember which one) that sells "pedi-bears". it's a little rubber teddy bear with an O2 jack in it's back that supplies blow by O2 out the bear's belly. Works great in the pre-hospital setting, you'd never get it to stay in front of the kids face all night though.

aloha

Jim

rehab nurse · Mar 13, 2006

well if its just a short time, transient thing, why are they using it in my pt's case.

first of all, let me explain what i'm doing. i'm doing an online care-planning conference in preparation for my CPNE through excelsior. so they make up a kardex and give you data and you have to make up a care plan about your patient. i'm having a real difficult time with it. so that's why i'm doing this conference with practice "patients".

and, i'm not a peds nurse by any means. i deal with adult rehab patients only. i've never heard of a "blow by". but according to this data, this patient is on the blow by all the time. i'll have to email my instructor again and ask her why the pt is having this type of o2. he's running pretty good on RA. he's on abt. has a h/o asthma. don't know what his baseline sats are. maybe she put it there on purpose to see if any of us would catch it? :idea: who knows.

aaaaaahhhhhhh! i hate care plans! :uhoh3:

thanks guys, i'll email my instructor and find out what why he's on this type of oxygen delivery system. and i'll let you all find out what she says! thanks for all your help!!

Pediatric Critical Care Columnist · Mar 13, 2006

We use blow-by a lot in our unit. (Yes, the self-same unit that wants to make an international name for itself but can't provide staff with simple things like user-friendly IV pumps, monitors that work and sliding aids...) Our RTs and docs say that the purpose is to provide supplemental O2 and humidity to the recently extubated or stridorous child in hopes of forestalling reintubation. This is in addition to nasal cannulae. Our set-up is a bit of a rig... we use the blue corrugated hose from a ventilator circuit and a special aerosolizer that creates a cold mist and adjusts from room air to 100% (I know, I know, Yeah Right... but that's what the valve says!). The end closest to the patient is wrapped in a multi-folded receiving blanket that is then taped in place. It elevates the hose to a point where the mist blows in the kid's face... as long as they lay absolutely still. Trying to position the snake on the bed in such a way as to make this actually work is a bit of a joke. Usually the hose is laying on the floor and the rolled-up blanket is under the kid's back, or else the bedding is soaked from rain-out and the kid's hypothermic. I hate it.

elizabells, BSN, RN · Mar 14, 2006

We use it in the admitting nursery on the post-partum unit where I did my LD clinicals. Just a pedi size face mask turned up to 10L in the warmer bassinet next to their heads. No more than 5 min at a time (yeah, right). O2 sat must be on. I suppose there is a time limit, as babes are not supposed to be in admitting longer than 4 hours. If they can't go to mom by then (i.e., haven't warmed up, can't hold their O2 sat) they are supposed to be reevaluated by peds for admittance to NICU or Special Care Nursery.