What should I do?

jadelpn, LPN, EMT-B · Jul 15, 2011

I have not seen a nasal cannula and a non-rebreather used at the same time. What does the order say? It should give a route of delivery, one or the other. If it doesn't I would get a clarification.

rusure · Jul 15, 2011

I'm not sure what the order is , but yes she IS wearing both @ the same time...all I know is I have never seen or heard of such.....need to know what I can do if it's possible.

nursetiffany. · Jul 15, 2011

are you a nurse? id look at the order and she what it says and then clarify if needed. both should not be worn.

SprightlySparrow, BSN, RN · Jul 15, 2011

Most of the time in an adult patient, one should not exceed 5L NC. Also, the fact that this lady is on two different delivery systems for her O2 is a little nuts if you ask me. This should most definitely be clarified...especially if her nose if bleeding!

psu_213, BSN, RN · Jul 15, 2011

I agree, get a clarification on the order. Also, get a humidifier for the O2 (the little "bubbler" of sterile water that gets screwed on to the O2 source) to help prevent the nose bleeds be keeping the nasal passages soft and "hydrated" (so so speak).

As for "blow the brain..." Where did you hear this? Do you mean mechanically blow the brain? Or such a high level of supplemental O2 can lead to O2 toxicity and (in COPD pts) increased CO2 retention? I've seen patients who are on 15 L NC (high flow) for long periods...and their brain did not "blow."

rn/writer, RN · Jul 15, 2011

Agree with above suggestions to clarify orders and humidify O2.

Using peroxide on Q-tips is sooo not a good idea. Peroxide can damage the delicate mucous membranes and leave her more vulnerable to nose bleeds. I'm sure you know this, but she might need to have it explained.

If she's on 6L of O2, she should be using a simple mask or a NRB mask. If, however, she doesn't like the mask, maybe she can use a face tent or some other delivery system.

Is Respiratory Therapy involved in her care? They would be the ones to investigate this further.

bjaeram · Jul 15, 2011

One oxygen source!

Humidified oxygen.

Vasaline to the nose.

EricJRN, MSN, RN · Jul 15, 2011

If you have a non-intubated patient who requires continuous end-tidal CO2 monitoring, some systems will allow you to monitor that via a nasal cannula setup while delivering high-flow oygen through a separate NRB mask. That's the only situation where I've seen a cannula and an NRB on the same patient.

I'm not 100% clear on your patient's situation, but if there is actually flow going through both devices, that just doesn't sound right.

Jenni811, RN · Jul 15, 2011

I'm really confused on this post.....

Why would you use non rebreather and nasal cannula at the same time?

why would someone not just use humidified air?

jadelpn, LPN, EMT-B · Jul 16, 2011

And...I don't know what the patient's diagnosis is, BUT--If the patient is "air hungry" due to COPD....well that is another whole can of worms and is really not in the patient's best interest, to say the least. And I would not put my license on the line continuing this way without specific orders on route of delivery, flow, humidified O2 or not, and what to do with the nose sores. What is the O2 sat. goal? I agree with vaseline in the nose, peroxide will erode the inside of the nose, and watch mouth care as well....if one gulps up enough O2 on the non-rebreather 24/7 the inside of patient's mouth will be a mess as well....If you are a nurse, I would be ultra sure that you get a clarification.

tokmom, BSN, RN · Jul 16, 2011

Does the patient use the cannula when she is eating and the NRB when she isn't?

Like the others said, the oxygen needs to be humidified.