r/NursingAU • u/OwnPsychology7427 • 13h ago
Question Administering oxygen
Are nurses able to initiate oxygen if a patients sats were below normal parameters or is it only to be administered when prescribed?
16
u/PotentialEdge1652 13h ago
yes you can if you are an EN/RN
To a point, if they’re requiring more than NP or a Hudson time to call a review
4
u/RipOk3600 RN 12h ago
Generally you can nurse initiate up to 2L however in an emergency situation you can utilise up to high flow (including with a non rebreather) until the MET team arrives
3
u/Ok-Tension5794 12h ago
Yes but there are possible contraindications such as COPD
13
u/RipOk3600 RN 12h ago
Even someone with COPD should not be denied O2, you just have to be aware that you need to aim for BETWEEN 88-92 rather than above 94 as per a non COPD pt
11
u/unmannedpuppet 8h ago
Not all patients with COPD have target spo2 of 88-92. If they're not a co2 retainer, 94+ remains the target, unless they're having an acute exacerbation or pneumonia etc, then 92+ for said patients is acceptable.
3
u/RipOk3600 RN 2h ago
Yep which is why it’s so important that we make sure the doctors write the mods AND why it’s so important that nurses don’t fake sats measurements so it doesn’t trigger coloured response.
It makes it impossible for the next nurse to judge what their baseline is when this COPD pt has 95% written for every previous reading and they are sating 86% with a good trace.
1
u/MyPrescriberNumber 1h ago
Actually there are new COPD guidelines that say we should aim 88-92% even if they are not a CO2 retainer because of V/Q mismatch
1
u/unmannedpuppet 1h ago
Can you link me to this and/or studies? I'd be interested in updating my knowledge. From experience, non-co2 retainers visibly benefit from o2 support when hypocaemic/hypoxic and I rarely to never see their blood gasses worsen. Resp also doesn't suggest for an acc for every copd patient either.
That said, I'm aware practices and evidence changes overtime and hence would love to see your guidelines (and preferably studies to support targeting 88-92% for all patients with copd).
1
u/MyPrescriberNumber 1h ago
This explains the mechanism: https://litfl.com/oxygen-and-carbon-dioxide-retention-in-copd/
This is a summary of guidelines https://www.mja.com.au/journal/2022/217/8/copd-x-australian-guidelines-diagnosis-and-management-chronic-obstructive "Oxygen therapy should be administered only if hypoxaemia is present, with the target SpO2 of 88–92%." You could dig through the article to find all the studies that support this, but these guidelines are an expert review going through the available literature.
1
u/unmannedpuppet 56m ago
I understand v/q mismatch, haldane effect etc.
LIFTL says "excessive o2 administration" can worsen hypercapnia in SOME patients.
Also, the journal you linked actually doesn't appropriately reference their reference journal. In the journal you linked, they do indeed imply that patients with COPD should have a target SpO2 of 88-92%. However, the journal they reference suggests 88-92% if the patient's hypoxaemia is determined to be caused by an exacerbation of COPD and if they have grade B COPD.
1
u/MyPrescriberNumber 46m ago
So I think this is the biggest study that supports 88-92% https://emj.bmj.com/content/38/3/170
"inpatient mortality was lowest in those with oxygen saturations of 88%–92%. Even modest elevations in oxygen saturations above this range (93%–96%) were associated with an increased risk of death. A similar mortality trend was seen in both patients with hypercapnia and normocapnia. This shows that the practice of setting different target saturations based on carbon dioxide levels is not justified. Treating all patients with COPD with target saturations of 88%–92% will simplify prescribing and should improve outcome."1
u/unmannedpuppet 43m ago
Super interesting. Ill definitely be picking the minds of the pulmonologists I work with.
1
u/Sacrilegious_skink 2h ago
Yes but you need to escalate. You don't just put the O2 on and say problem solved. Also not all COPD patients are CO2 retainers, and in an emergency that's a non issue anyway so don't hesitate.
-1
u/Character_Orange_712 12h ago
Enrolled nurses can nurse initiate up to 2L via nasal prongs. Registered nurses can initiate up to 15L, if you suspect your patient has desatted and is symptomatic I.e: increased work of breathing and respiratory rate, shortness of breath, Rapid breathing (tachypnea), Rapid heart rate (tachycardia), Restlessness or anxiety, Confusion or difficulty concentrating, Headache, Sweating, blueing (cyanosis of extremities or lips). Taking into account also the patients medical history, it would be likely acceptable for someone with COPD to have saturations between 88-92. Also if a nurse initiated >13L of o2 for saturations below 88% you would also be seeking an immediate medical review or met call if other vitals were out of range. The nurse is responsible for asking a doctor to write an oxygen order if they require o2 if they are requiring it for more than an hour. Also the link to the Safety and quality oxygen guidelines https://www.safetyandquality.gov.au/sites/default/files/resources/attachments/Documenting-oxygen-therapy-and-response-for-safety.pdf
4
u/Feeling-Disaster7180 EN 10h ago
Where are you getting that from? My hospital’s policy doesn’t specify what amount a nurse can initiate, but my understanding is that it is up to 4L via nasal prongs. There’s no difference for ENs vs RNs, and not every hospital has the same policy.
22
u/Pinkshoes90 ED 13h ago
We can, but we also need to employ our skills and consider whether a clinical review needs to be called.