PLACE LABEL HERE

OXYGEN (O2) for ADULTS

INITIATION and WEANING

PROTOCOL

The following orders will be implemented by Nursing or Respiratory Care

per physician order of Oxygen Therapy (policy # 500-16).

When Oxygen (O2) is ordered for an adult patient, the following protocol will be used

(Exceptions: Intubated patients receiving mechanical ventilation & fetal indications in pregnancy)

1. Patient has an indication for O2, continue Oxygen

If patient does not have an order for O2, call physician to obtain an O2 order

Indications for Oxygen:

· Documented hypoxemia: PaO2 < 60 torr or SpO2 < 90%, or < 88% in COPD, < 95% in pregnancy (non-fetal indications)

· Acute care situation in which hypoxemia is suspected until absence of hypoxemia is established by pulse oximetry or ABG. Instances which could indicate hypoxemia include:

o Increased respiratory rate > 20 bpm not attributed to another cause such as pain.

o Patient is utilizing accessory muscles or appears to have labored breathing.

o Carbon monoxide toxicity or increased methhemoglobin

· Severe Trauma, see ED Guidelines, policy # 6911-14

· Acute Stroke within past 24 hours

· Acute Myocardial Infarction within the past 6 hrs

· Short term use post-operatively (Patients with OSA or Suspected OSA, see Policy 500-57)

· Patient using O2 at home

2. Perform patient assessment to include RR, SpO2, diagnosis, previous ABG, home O2

3. If O2 no longer needed, decrease the O2, keeping SpO2 > 90%, check saturation at 10-15 min intervals

Exceptions, keep SpO2 : > 88% in COPD patient

> 94% in Acute Stroke patient for the first 24 hrs, then > 90%

> 95% in Pregnant patient (non-fetal indications)

Home O2 patient, wean to home O2 setting (unless ordered otherwise by physician)

4. If able to wean to room air while maintaining the appropriate SpO2 and patient has no indications for oxygen, recheck SpO2 within 1 hr. If SpO2 remains > 90% (or > 88% in COPD patients, > 95% in pregnant patients with non-fetal indication) and no respiratory distress is noted, DC O2.

If unable to wean to room air, adjust O2 to lowest FiO2/Liter flow needed to maintain appropriate SpO2. Continue daily monitoring.

5. Notify physician if O2 requirements are > 4L/M or 40% (unless patient on this amount at home) or has to be restarted.

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Date Time Physician Signature PID Number

Send copy to pharmacy

*1-34431* FORM 1- 34431 INITIATED 12/2013 Page 1 of 1