Question about FiO2

kctwinmommy · #1 03-27-2010, 10:58 PM

Maybe we're just not getting it, although we're pretty sure that we're correct. Kira's on the vent 24/7 basically, with an oxygen concentrator at night. Usually, when healthy, she's on about 1 l.p.m. Now, we know that room air is 21% oxygen. However, we were also told that approximately every 1 liter that it's increased, it goes up about 4%. We had one of those analyzer things when she was in the hospital, so we know that 2 l.p.m. is 28%.

Now, our one new nurse (an RN) told us the way we're thinking is correct. This percentage doesn't change no matter who the patient is. It's true that the patient may not be using/getting all of that 21 or 28%, but it's still what they're getting. But one of the other nurses, who's been showing more signs of lack of training and other issues, is trying to tell us that they chart 28% since that's what the doctor's orders said. Even when she's on room air or only on 1 liter. So we've got nurses charting nothing at night, when she's always on some oxygen. Then others charting RA (room air) or 28% during the day. It should be RA all day from when she gets downstairs until she goes to bed, then either 24 or 28% depending on her needs.

Are we wrong in this!?!?! Or is the one nurse truly not knowledgeable in her job!?!?

drct1245 · #2 03-28-2010, 12:37 AM

When Ayden was on O2, since there was no analyzer, our nurses charted the amount in liters as that was the only way to consistently measure how much O2 he is on... also, mind you that an oxygen concentrator or is only 90-93% pure O2, so the % is probably less.

So when we switch from tanks to concentrator, we have to bump Ayden up about 50% to keep the sats equal to what he was on while on a tank. For sanity sake, have them chart in L - you might need a Dr note for them to do so, though.

momma3 · #3 03-28-2010, 01:11 AM

I hope I'm understanding the question correctly so this answer makes sense. As a nurse I can say that it doesn't matter what the drs order is, you chart what is happening. The chart can turn into a legal document in court (if need be) so it should be truthful. Even if there was a drs order for 1L O2 and the pt is on 2L, you chart 'pt on 2L O2'. If she is on RA during the day, that should be what is charted, then whatever she is on at night should be charted, whether that is 1L or 2L. Not sure why they chart in % (i've never seen anyone do that but I work in a hospital, maybe home health is different?) but even so, it should be correct.

CCHSMOM · #4 03-28-2010, 01:56 AM

My daughter is on room air now (unless she is in the hospital with a pulmonary infection), but used to be on 4L/min of O2. The only time I've ever seen the oxygen recorded/ordered as a percentage is in the hospital when the vent is connected to the wall source O2 AND the vent has it's own O2 control. Then the doctor orders a certain percentage and RT programs the vent for that amount. Otherwise, I've always seen the O2 ordered and charted in L/min. If you're bleeding the O2 into the vent circuit, it should be charted as L/min and not as a percentage.

Momoffive · #5 03-28-2010, 07:09 AM

Charting can make me crazy!! I'm in the camp that the nurses should be charting the O2 in L. I know that we had to get a new order at one point because one nurse felt the standing order didn't address what the max. flow that they could hand ventilate with the amubag was and that she would only go to 3L b/c that was the existing order for maintaining sats above 92; the rewritten order included a provision for higher flow for hand ventilating. I appreciate that "momma3", as a nurse, has reinforced that nurses should be charting what is happening - I'm not sure if all parents read the chart in the home, but I do, and I would be looking at that and saying to them, so, you didn't have the O2 on all last night? because that is what it would look like to me.

drct1245 · #6 03-28-2010, 09:16 AM

Oh and the other thing I forgot mention, is with our vent (not an LTV) you were ALWAYS supposed to leave the FiO2 setting @ 21%, unless there was a special adapter they had in the hospital, but not at home. I don't know if your vent is the same, but just an FYI. For us it didn't matter what that was set at, it was always at the source of the O2.

And should your child ever get off the vent and still be on O2, you want to make sure that it's being charted correctly because the O2 could keep your nursing around when the vent is gone.

kadiera · #7 03-28-2010, 09:52 AM

Yup - they're supposed to chart exactly what they're doing. Since they don't have a monitor to check, they should be charting in liters/min. We actually had them measure when we were having problems with the mist collar, and found that the 4% rule works coming out of a tank, but not necessarily out of a concentrator, and that the end result with the mist collar was not linear (a half liter was 22% at the mask, a liter was 27%, and two liters was only 29%, as I recall)

I'd call the nursing agency and ask/complain about that...

kctwinmommy · #8 03-28-2010, 01:46 PM

OK, thanks everyone! They're charting it with the percentage cuz they have a spot on their chart for FiO2! So I guess technically they can't truly chart it unless we had the analyzer to tell us exactly what the percentage is. Just another issue we're having! Yeah! NOT!!!