Too much oxygen?

RN_EMT · Jan 30, 2015

Addendum:) its a pediatric and has had transposition of the great vessels

FlyingScot, RN · Jan 30, 2015

Was this child repaired and if so what procedure was done?

No this is not "overboard". Too much oxygen on a kid with CHD can kill them.

GrannyRRT · Jan 30, 2015

What was the SpO2 of the patient during report?

Was this s/p repair?

Was the cannula on a blender? (I would hope if this is a cadiac child.) 5 l/m @ 21% is not the same as 5 l/m 100%

What kind of unit or floor do you work on that has a "prescribed" flow? I would be calling that doctor for EVERY SpO2 change and for every FiO2 fraction change with an update on the SpO2.

How much orientation did you get for working with cardiac kids? This should be a clinical judgment based on your education concerning the safe management of a patient when too much FiO2 and a high PaO2 or SpO2 can do harm.

meanmaryjean, DNP, RN · Jan 30, 2015

A peds cardiology patient requires you to suspend what you 'know' about oxygen and appropriate sats/ ABGs - and learn an entirely different set of normals (plus a minor in plumbing!)

FlyingScot, RN · Jan 30, 2015

For your edification google Mustard/Senning and arterial switch procedures. Also look up shunting related to TGA kids both pre and post op. Have one of the cardiovascular surgeons or NPs draw you a diagram of the kiddo's plumbing. You need to do this to really understand why lower sPO2s are desirable with this particular patient or really any child with certain CHDs. It's absolutely vital that you understand the whys and hows for you to safely care for these types of patients.

RN_EMT · Jan 30, 2015

Flyingscot- I believe this pt had the rastelli procedure

GrannyRRT- I should have specified, he is on humidified 21%( that was the one left on 5lpm), nasal cannula @ 3lpm during speech therapy, t-collar@ HS, and vent PRN. I work in a home setting it is why we have prescribed O2 by pulmonologist. I have been a medic for 7 yrs and an RN for three. I do 911 ems and emergency room and ICU, MICU, ACLS instructor. I got oriented for several weeks and do believe to be qualified to work with cardiac kids.

flyingscot-thanks for the sources I will do that. I have done some research online and my old pediatric book before starting the case so I wouldn't be lost my first day and do have a good understanding on it.thanks

Thanks meanmaryjean couldn't agree more

hope this helps guys...thanks

GrannyRRT · Jan 31, 2015

Flyingscot- I believe this pt had the rastelli procedure
GrannyRRT- I should have specified, he is on humidified 21%( that was the one left on 5lpm), nasal cannula @ 3lpm during speech therapy, t-collar@ HS, and vent PRN. I work in a home setting it is why we have prescribed O2 by pulmonologist. I have been a medic for 7 yrs and an RN for three. I do 911 ems and emergency room and ICU, MICU, ACLS instructor. I got oriented for several weeks and do believe to be qualified to work with cardiac kids.
flyingscot-thanks for the sources I will do that. I have done some research online and my old pediatric book before starting the case so I wouldn't be lost my first day and do have a good understanding on it.thanks
Thanks meanmaryjean couldn't agree more
hope this helps guys...thanks

Very little of that adult experience adequately prepares you for a pediatric cardiac patient like this. ACLS definitely does not cover CHDs in children. You should consider doing acute care on a pedi surg floor.

I also suggest at the very least take the S.T.A.B.L.E cardiac class.

e is on humidified 21%( that was the one left on 5lpm),
nasal cannula @ 3lpm during speech therapy,
t-collar@ HS, and vent PRN.

This is not the typical TOGV patient.

If the patient has a trach, why only 3 L of humidified flow? Most aerosol generators require at least 5 L of flow. We run ours no less than 6 L on neo and pedi trachs. Is this a venturi device? This is a DME or vendor issue in regards to the correct operation of the equipment. Pulmonologists probably don't know the equipment.

Is the NC on 3 L or 21% or 3 L via concentrator at 94 - 99%?

This patient is a very complex patient if he is requiring a ventilator and 3 L of Oxygen. What are his pulmonary problems, degree of pulmonary hypertension and cardiac function? Was he on ECMO? I suspect he is now very much a pulmonary patient since a cardiac function issue would not allow him so much time off the ventilator. What pulmonary vasodilators is his on? Sildenafil?

This is not just one issue as your initial post presented.

RN_EMT · Jan 31, 2015

Hey there maybe I made this patient seem sicker than he really is. He's not in a hospital, is completely weened off the vent, has a t-collar, only wears cannula with speech therapy, is stepping down from trach and then completely gone. He's not on any pulmonary vasodilators. I do have pals and stable course and numerous airway and vent classes. I think I found my answer though while doing research and speaking to pulmonologist. I really appreciate all the input, really helped in finding my answer í ½í¸ƒ

JWG223 · Jan 31, 2015

Well stated, peds are not "just little adults".

psu_213, BSN, RN · Jan 31, 2015

What kind of unit or floor do you work on that has a "prescribed" flow? I would be calling that doctor for EVERY SpO2 change and for every FiO2 fraction change with an update on the SpO2.

I once took care of a patient with pretty severe COPD (an adult), and the doctor wrote an order "ABG before every change in O2 flow rate. Call pulmonology with each change in O2." The patient was only on a couple liters NC.

JWG223 · Jan 31, 2015

I once took care of a patient with pretty severe COPD (an adult), and the doctor wrote an order "ABG before every change in O2 flow rate. Call pulmonology with each change in O2." The patient was only on a couple liters NC.

Doctors write some absurd orders at times, though. I wouldn't go by an order except to manage that one patient by legal standards. It's not a case study, in and of itself, for sure.