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Wednesday, November 20, 2013

What if you find the oxygen off?

Where I work there is no piped in air.  When we do breathing treatments we use the oxygen flowmeter.  We disconnect whatever oxygen is being used at the time, and hook up the oxygen tubing to the nebulizer.

You can see a couple potential problems that may develop here.

1.  What if a patient is a CO2 retainer?  Let me answer this by saying this:  "In my 42 years of doing this job, I have never once, ever, had a patient, COPDer or other, drop dead during a treatment!"  If you think the approximately 60% FiO2 the patient receives during a 5-10 minute breathing treatment may knock out a retainers drive to breath, you should check out this post.  

2.  What if you forget to hook up the patient's oxygen?  This was the first real dilemma to occur to me when I started working as an RT.  What I quickly learned to do was to coil the end of the O2 tubing and hook it over the flowmeter.  Then, when I'm disconnecting my breathing treatment, I see the coil and remember to reset up the patient's oxygen.  It's kind of like tying a string around your finger.

Yes, I did get into trouble more than once because I forgot to hook up the oxygen, and I'm not alone.  But still, when a nurse tells you what you did, you feel stupid. And, yes, I caught nursing doing the same thing on many occasions. Most of the time I fix the problem and say nothing.

But, there has been the rare occasion, like at a code, when I noticed a patient being bagged was still blue and flowmeter the bag was hooked up to was off.

There have also been rare occasions where I skip this step.  The only times I get into trouble are when I skip a step.  Usually it happens when I'm tired in the wee hours of the morning.  Or it happens when I'm at the tail end of a long shift.  Shortcuts are not short when you're sitting in an office two days later trying to walk your way out of your error.

So, when do you confront a nurse about her error?  When do you tell a doctor you screwed up? Rule of thumb here: if the patient's health was affected by the error, then you have no choice but to tell the doctor.

It happens.

Another strategy I have developed (an automaton strategy as Jane would say) is every time I leave a room, I reenter the room to recheck the oxygen.  This catches most errors before they develop into a problem.

Likewise, every time I'm at a code, I check the AMBU-bag (even if I'm not the one bagging).  I walk up the O2 tubing from the bag all the way to the wall.  I do this because there was one time when O2 tubing was plugged into the wall, and later on we realized it wasn't the AMBU-bag but the nasal cannula.

It's a fail safe mechanism.  And, regardless of who plugs the equipment into the wall, I feel it is my responsibility, as the RT, to make sure the equipment is plugged in and working properly.  I do this even if I'm just a bystander watching the code.  I do this even if I see an elite doctor or nurse plug in the bag.  It's just something I've learned to do.  It provides that wee bit of reassurance.  So if I'm sitting in the bosses office the next day I can say with 100% assurance that the bag was plugged in and turned on.

Which reminds me of last Halloween.  I took my grand kids to a nursing home to go Trick-or-Treating.  The hallways of the home are packed.  The staff and patients are busy being happy seeing all the awesome costumes.  No one hears the audible hissing.  I do.

I look around and find a little old COPDer is wheeling down the hall with his nasal cannula on, but not hooked up at the wall.  I hook it up just before the old man was out of my reach.  He continued on his way with oxygen.  He never knew I provided this little service.

Anyway, my point here is to be careful with the things you do every day.  It may become habit to just do the breathing treatment, or just bag at a code, but it always pays to be vigilant.

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