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MRSJOH
04-01-2009, 07:07 AM
jasper is on room air for his mist collar, everytime we get a new room the nurse setting up wants to put the humidifier to the oxygen at 21%, he is a cardiac patient with a shunt, he cannot have oxygen, I try to explain this to them ( and we are on a cardiac floor by the way) but they try to tell me - there is oxygen in the air, (wow really) it's the same thing, it's not until i have respiratory down and they say it isn't the same thing, let us get the set up... then they do it,

how can I explain it, what am I doing wrong???

My little figther
04-01-2009, 07:21 AM
Oxygen is pure and Air is not - here is the complete explanation - sorry it will be so long but hopefully that would make the difference clear.

Air and oxygen are sometimes used interchangeably, but the two things are actually different. Oxygen is a pure element, while the air we breathe is a mixture of elements. Although oxygen is necessary for survival, repeated exposure to pure oxygen could be harmful. The air which makes up our atmosphere has a healthy balance of elements to sustain human life.

Oxygen is a pure gaseous element. Prolonged exposure to pure oxygen can actually cause brain damage, although the element is sometimes used therapeutically. Most animals require a certain concentration of oxygen in their blood in order to thrive, and for this reason oxygen is used in emergency situations in which access to air is restricted. When used therapeutically, oxygen is usually mixed with other elements. It is rare for a patient to be given pure oxygen.

Oxygen is number eight on the periodic table, which means that it has eight electrons and eight protons. Only a handful of elements, including helium and hydrogen, are lighter than oxygen. Oxygen has a cubic structure and is a totally colorless element.

The air we breathe is a mixture that contains primarily oxygen and nitrogen. The nitrogen generally makes up approximately 78% of the air, while oxygen makes up 21%. Other gases including carbon dioxide, hydrogen, helium, argon, and neon make up the remainder. These gases dissolve and are carried in the blood.

Anyone who has experienced radical pressure changes is familiar with the effects of dissolved nitrogen in the blood. While nitrogen is normally carried in the blood without any ill effects, extreme depressurization can cause the nitrogen to form gaseous bubbles in the blood. This causes extreme pain and can lead to death, in a condition known to divers as the bends.

The term air is also used to refer to the Earth’s atmosphere as a whole, which makes life on Earth possible. Air forms the lower part of the atmosphere, and becomes thinner the further the observer is away from sea level. Thin air refers to air which is less dense than that at sea level. On Earth, people at high elevations experience thin air, which can cause shortness of breath and nausea. Thin air has less oxygen, which means that the body must work harder and breathe more quickly to extract the necessary amount of oxygen from the air.

Most creatures tend to take air for granted, because it is an abundant substance. However, increasing pollution has led to a decline in air quality, which has resulted in health problems for some animals. Air which is heavily contaminated with particles in high concentrations can damage lung tissue. Bad air quality can sometimes be physically seen in the form of smog, a heavy collection of hydrocarbons in the atmosphere.

Michelle

DadOf24Weeker
04-01-2009, 07:24 AM
Since the "room-air" that we all breathe contains 21% O2 and 79% Nitrogen, in theory, having someone on 21% O2 is equivalent to having them on room-air.

When Sahana was in the NICU, she'd often not need any supplemental O2 i.e. be on room-air but at times would need a slight bump. The way they had the circuits and tubes connected, the O2 tube was always connected into the vent, with the O2 at 21% until she needed a boost.

I don't know if things would've been done differently had she had any cardiac issues.

When you have the RTs/Resp. nurses together with the Cardiac nurses, you may want to play the "dumb parent" and ask the RTs to explain the difference between not having the O2 connected at all and having it connected but dialed down to 21%. Besides, if your child is able to maintain his sats without any supplemental O2, ask the Cardiac nurses why they feel the need to leave the O2 connected (even if it's at 21%)?

Hope this helps ...

Harish

TommysMommy
04-01-2009, 08:07 AM
Bring it up during rounds to his attending. Whenever Tommy was in the hospital, our orders were written that I adjusted his O2 accordingly. The RTs brought us our supplies and let me set it up however Tommy needed it that day. Not to say that they would just leave us hanging if we needed help, it was just that I could tweak the settings without getting a nurse or RT every time. Ask the RT how to set it up correctly and then you will know how it needs to be done. If the nurses insist on doing it incorrectly, and you have orders that you are allowed to maintain it, just change it when they leave.

KJKK8437
04-01-2009, 08:19 AM
I think what some of the folks are telling you is that 21% O2 is equivalent to room air since it is the same concentration of oxygen as is in the room air that we breathe when walking around. So, by putting the mist setup on a 21% O2 push, they are putting no more O2 in the system then is in the air and it should be the same thing.

This is only theoretically true. Yes, 21% oxygen is the concentration of O2 in the air in the room, but you cannot manufacture that kind of concentration with accuracy through a mist collar on a hospital setup. We have had this problem many times. As Harish mentioned, a 21% oxygen set up (rather than just a room air setup) will often cause a small bump in sats. When we were having problems with Alex maintaining his sats, and he would trial off the oxygen we would insist that Alex use the room air setup to see what he was REALLY doing. The pulmonologist agreed completely with this.

Others -- nurses, RTs, said, "It isn't that much of a bump to really matter." Well, if you are concerned about whether the child can support sats of 92 or above without any support, then it does matter. If the extra bump makes him 92 when he otherwise would be 91, that is the difference between discharge and another night in the hospital.

Eventually, everyone came around to my (and the doctor's) way of thinking.

This is totally my opinion, but if the criteria is that your child is to be on humidified room air, then it should be a room air push through the humidity water. It should not be a 21% O2 mix. Yes, the concentration is theoretically the same, but it isn't a natural concentration, and it isn't what you would get at home.

Having said all that -- there is one pretty good reason why hospital staff might want to use an O2 push set at room air settings rather than a room air push. If there is an emergency, it is way easier to turn the O2 dial to get the oxygen concentration up then it is to hookup a whole new setup. To deal with that problem, we had two setups in our room at all times. On was set up to the O2 valve and usually left alone. The other was the room air mist that Alex used in the bed. If he had a desat, we switched from one trach collar to the other. (Or, sometimes we only had two bottles set up, and we yanked the tubing from one setup and put it on the other.)

I hope this made some sense.

llwilliams8
04-01-2009, 11:00 AM
If you have a concentrator that is pulling the room air and converting it into oxygen is it pure oxygen is it converting it into? When my daughter is on .25 liters is that a little less of a concentration that the .,25 liters on an oxygen tank since it is being converted from room air and not just pure O2? Our DME company said it was not 100% O2 and more like 94% of O2 but I wonder why at times she needs this very small boost when she's sleeping to keep her saturation levels from 91 to 92. She does ride the vent when she is sleeping.

suzanne2545
04-01-2009, 11:45 AM
Karin said it exactly the way I would have.

Get specific orders and make a sign to put on his bedside, as one thought.

babybear
04-01-2009, 07:34 PM
I would insist on a room air setup. When Gabriel's in the hospital, the lowest setting the oxygen setup will go to is about 22-24%, it isn't even an exact percentage. So, unless Gabriel needs supplemental oxygen, he gets the room air setup. The two lines are immediately adjacent to each other, so it shouldn't be any trouble for Jasper's nurses to put him on room air. Good for you for questioning them!

Ainsley's Mom
04-02-2009, 03:46 AM
Wow I learned a few things reading this post. But I do have one thought, could you get the RT or doctor to make a no oxygen sign that gets taped to his crib? I'm scared thinking of what could happen if you happen to be away from his bedside.

MRSJOH
04-03-2009, 11:01 PM
thanks! yes I will make a sign for his bed, a few Rt's and his cardiologist and this awesome trach nurse will explain to the nurses and others that claim it's the same thing , that it is not, Jasper should be sating in the 80's, with any 02 he will be 100, very bad, I will sit with the head rt guy and get his wordage for how to write it,

thanks!!!