Too much oxygen?

Hi, I have a patient with low oxygen levels(72%-80% normal). I was always pushed as a paramedic to promote oxygen(different theory of medicine) and as an RN your taught risks and benefits of too much oxygen. This nurse was going to report a RN on the case for accidentally leaving the patient @5lpm instead of the prescribe 3lpm stating this was too much and was harming the patient. I personally think it was kind of overboard?????? Comments??
Addendum its a pediatric and has had transposition of the great vessels

Was this child repaired and if so what procedure was done?No this is not "overboard". Too much oxygen on a kid with CHD can kill them.

What was the SpO2 of the patient during report?Was this s/p repair?Was the cannula on a blender? (I would hope if this is a cadiac child.) 5 l/m @ 21% is not the same as 5 l/m 100%What kind of unit or floor do you work on that has a "prescribed" flow? I would be calling that doctor for EVERY SpO2 change and for every FiO2 fraction change with an update on the SpO2.How much orientation did you get for working with cardiac kids? This should be a clinical judgment based on your education concerning the safe management of a patient when too much FiO2 and a high PaO2 or SpO2 can do harm.

A peds cardiology patient requires you to suspend what you 'know' about oxygen and appropriate sats/ ABGs - and learn an entirely different set of normals (plus a minor in plumbing!)

For your edification google Mustard/Senning and arterial switch procedures. Also look up shunting related to TGA kids both pre and post op. Have one of the cardiovascular surgeons or NPs draw you a diagram of the kiddo's plumbing. You need to do this to really understand why lower sPO2s are desirable with this particular patient or really any child with certain CHDs. It's absolutely vital that you understand the whys and hows for you to safely care for these types of patients.

Flyingscot- I believe this pt had the rastelli procedure GrannyRRT- I should have specified, he is on humidified 21%( that was the one left on 5lpm), nasal cannula @ 3lpm during speech therapy, t-collar@ HS, and vent PRN. I work in a home setting it is why we have prescribed O2 by pulmonologist. I have been a medic for 7 yrs and an RN for three. I do 911 ems and emergency room and ICU, MICU, ACLS instructor. I got oriented for several weeks and do believe to be qualified to work with cardiac kids.flyingscot-thanks for the sources I will do that. I have done some research online and my old pediatric book before starting the case so I wouldn't be lost my first day and do have a good understanding on it.thanksThanks meanmaryjean couldn't agree morehope this helps guys...thanks

Quote from RN_EMTFlyingscot- I believe this pt had the rastelli procedure GrannyRRT- I should have specified, he is on humidified 21%( that was the one left on 5lpm), nasal cannula @ 3lpm during speech therapy, t-collar@ HS, and vent PRN. I work in a home setting it is why we have prescribed O2 by pulmonologist. I have been a medic for 7 yrs and an RN for three. I do 911 ems and emergency room and ICU, MICU, ACLS instructor. I got oriented for several weeks and do believe to be qualified to work with cardiac kids.flyingscot-thanks for the sources I will do that. I have done some research online and my old pediatric book before starting the case so I wouldn't be lost my first day and do have a good understanding on it.thanksThanks meanmaryjean couldn't agree morehope this helps guys...thanks

Hey there maybe I made this patient seem sicker than he really is. He's not in a hospital, is completely weened off the vent, has a t-collar, only wears cannula with speech therapy, is stepping down from trach and then completely gone. He's not on any pulmonary vasodilators. I do have pals and stable course and numerous airway and vent classes. I think I found my answer though while doing research and speaking to pulmonologist. I really appreciate all the input, really helped in finding my answer ����

Well stated, peds are not "just little adults".

Quote from GrannyRRTWhat kind of unit or floor do you work on that has a "prescribed" flow? I would be calling that doctor for EVERY SpO2 change and for every FiO2 fraction change with an update on the SpO2.

Quote from psu_213I once took care of a patient with pretty severe COPD (an adult), and the doctor wrote an order "ABG before every change in O2 flow rate. Call pulmonology with each change in O2." The patient was only on a couple liters NC.

Quote from JWG223Doctors write some absurd orders at times, though. I wouldn't go by an order except to manage that one patient by legal standards. It's not a case study, in and of itself, for sure.