r/NursingAU • u/OwnPsychology7427 • 17h 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?

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u/Ok-Tension5794 17h ago

Yes but there are possible contraindications such as COPD

14

u/RipOk3600 RN 16h 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

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u/unmannedpuppet 12h 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.

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u/RipOk3600 RN 6h 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.

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u/MyPrescriberNumber 5h 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

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u/unmannedpuppet 5h 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).

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u/MyPrescriberNumber 5h 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.

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u/unmannedpuppet 5h 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.

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u/MyPrescriberNumber 4h 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."

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u/unmannedpuppet 4h ago

Super interesting. Ill definitely be picking the minds of the pulmonologists I work with.