This brings me to RT Cave Rule #10
RT Cave Rule #10: Nasal cannulas do not belong in mouths. Not only is this not necessary, it is unsanitary. The nasal passages and sinuses act as a reservoir for oxygen entering via the nasal cannula. Even if the patient is a mouth breather, or has a stuffy nose, the patient will still entrain oxygen via a properly inserted nasal cannula.
- The patient is in a deep sleep
- The patient is mouth breathing
- The patient is has a stuffy nose
Thus, she decides that the nasal cannula should be placed in the mouth. Then, an hour later, the RT comes around and does one of the following actions:
- He takes the cannula out of the mouth and places it back where it belongs, and leaves it at that.
- He takes the cannula out of the mouth, and proceeds to educate the RN as to why this is not necessary and not sanitary.
- He does nothing. He's tired and doesn't want to deal with it at the moment. Or, he's explained it so many times already he doesn't see what the point would be.
I have found myself in all three of these scenarios. Most of the time if it is a new nurse I explain why the cannula should not be in the mouth, but if it's a habitual offender, I might do action 1 or 3.
Okay, so the patient has a stuffy nose. The oxygen will find a way to work its way around the stuffy stuff, and make it to the patient's lungs.
Okay, so the patient is a mouth breather. The oxygen will still be entrained into the nasal passages and to the nasal sinuses and will still be entrained.
Okay, so the patient's sats have dropped. Check the connections. Turn up the oxygen. Assess the patient. Consider the patient's age and history and decide if it might not be normal for that patient to have a slightly lowered sat while from time to time, and leave the oxygen where it is.
Consider this too: it is normal for aging patients to have lower sats. It is also normal for elderly and chronically ill patients (like COPDers) to have decreased sats when they are sleeping. And, in the case of some COPD patients, sats in the high 80s can often be normal. So know your patient's history.
If the patient is in respiratory distress, or if you continue to be perplexed or concerned about the low sat, call RT. That's what we are here for. But -- please -- do not place the cannula in the mouth.
Think of it this way: would you want something that was stuffed into your nose in your mouth. I wouldn't. If a patient needs more oxygen, there are other options.