Oxygen Contra Indications

Scout

Scout

Para-Noid
Messages
576
Reaction score
2
Points
18
Has anyone heard of a Bleomycin lung injury being a Conta indication for 02 admin

They are coming in in our new protocalls, and TBB its the first I've heard of it. Anyone care to hop in on this. Is it normal?
 
This type of pneumonitis gets the full ARDS protocol to get under an FiO2 of 0.40 and corticosteroids which may already have been done.

Pneumocystis Pneumonia (PCP) is also more susceptible to hyperoxia but then many of of the inflammatory itis processes are.

Of course there is a delicate balance when weaning the FiO2 on a patient and maintaining adequate PaO2 and tissue oxygenation. As well the pressors and fluids given to maintain MAP of the BP to support the required MAP of the ventilator may also take a toll on the patient as well as help.

This is why new ventilation technology and gases such as HeliOx and Nitric Oxide makes Respiratory Therapy or being an ICU RN an exciting profession because new things show up constantly and protocols are reworked to incorporate the new changes.

BTW, in the field you will probably not know about these inflammatory processes even if you suspect. Depriving the patient of O2 in the short term until the technology, meds and gases are set up can kill the patient also in the short term.

Cyanotic Heart Diease with ductal dependent lesions is one area where you want to avoid administering a high FiO2 unless you have the ability to keep the ductus open. Of course, this should have been diagnosed prior to birth or transport. If not, an experienced neonatal team will do their FiO2 test upon their arrival.

The other issue is with Paraquat poisoning and administering O2.
 
Last edited by a moderator:
These are the guidelines for RTs and O2 administration from the AARC guidelines.

[FONT=TimesNewRoman,Bold][FONT=TimesNewRoman,Bold]
6.0 PRECAUTIONS AND/OR POSSIBLE COMPLICATIONS:
6.1​
​
[/FONT]​
[/FONT]With PaO2 > or = 60 torr, ventilatory depression may occur in spontaneously breathing patients with elevated PaCO2. ​

[FONT=TimesNewRoman,Bold][FONT=TimesNewRoman,Bold]
6.2​
​
[/FONT]​
[/FONT]With FIO2 > or = 0.5, absorption atelectasis, oxygen toxicity, and/or depression of ciliary and/or leukocytic function may occur. ​

[FONT=TimesNewRoman,Bold][FONT=TimesNewRoman,Bold]
6.3​
​
[/FONT]​
[/FONT]Supplemental oxygen should be administered with caution to patients suffering from paraquat poisoning and to patients receiving bleomycin. ​

[FONT=TimesNewRoman,Bold][FONT=TimesNewRoman,Bold]
6.4​
​
[/FONT]​
[/FONT]During laser bronchoscopy, minimal levels of supplemental oxygen should be used to avoid intratracheal ignition. ​

[FONT=TimesNewRoman,Bold][FONT=TimesNewRoman,Bold]
6.5​
​
[/FONT]​
[/FONT]Fire hazard is increased in the presence of increased oxygen concentrations. ​

[FONT=TimesNewRoman,Bold][FONT=TimesNewRoman,Bold]
6.6​
​
[/FONT]​
[/FONT]Bacterial contamination associated with certain nebulization and humidification systems is a possible hazard. ​

[FONT=TimesNewRoman,Bold][FONT=TimesNewRoman,Bold]
​
[/FONT][/FONT]
 
OK but how do i tell the person has a Bleomycin lung injury on an ambulance with just my noggin and a sp02 moniter.

Or will it be a case of "Sir are you recieving Bleomycin atm", then you with hold the o2?

I have never come accross this and it will be some time before we get upskilling on the issue.
 
Scout said:
OK but how do i tell the person has a Bleomycin lung injury on an ambulance with just my noggin and a sp02 moniter.

Or will it be a case of "Sir are you recieving Bleomycin atm", then you with hold the o2?

I have never come accross this and it will be some time before we get upskilling on the issue.
Click to expand...

Look up what Bleomycin is used for. If you have transported cancer patients receiving chemo treatments, you may already have seen patients taking Bleomycin.

The guidelines should not tell you to withhold oxygen but in situations where there is a chance for O2 therapy to be prolonged such as in a surgical procedure or where high concentrations might be used, precautions should be taken. A modified ARDS protocol may be utilized when the patient is intubated. As well if they are showing signs of developing a pneumonitis that is not responsive to treatment and their FiO2 requirements are getting greater than 0.40, the patient may be intubated and a protocol may be initiated in attempts to lessen the requirement.

Not everyone taking Bleomycin will develop pneumonitis. In fact, it is fairly rare to have such severe cases although some pulmonary fibrosis is noted and many of these patients are monitored in our Pulmonary Labs to monitor their lung function.
 
Interesting, I'm not working till next week, I'll bring it up then, if not i guess it will be on to A doc or two.


Thanks for the input.
 
Scout said:
Interesting, I'm not working till next week, I'll bring it up then, if not i guess it will be on to A doc or two.
Click to expand...

Who initiated the protocols you mentioned in your OP?

I hope they are doctors and have chosen their wording of these protocols very carefully.
 
death is a contra indication.
 
Linuss said:
You withhold oxygen during a cardiac arrest?

0_o
Click to expand...

they haven't been pronounced dead. If they have your working codes for no reason.
 
I was taught never to withhold oxygen. In a response you shuold be ok giving it for the 10 minutes to the hospital. If you are doing an IFT, then the transferring doctor might tell you not to use O2.
 
WuLabsWuTecH said:
I was taught never to withhold oxygen. In a response you shuold be ok giving it for the 10 minutes to the hospital. If you are doing an IFT, then the transferring doctor might tell you not to use O2.
Click to expand...

You're a student at Wash U and have fallen into the trap of every patient gets O2 unless explicitly ordered otherwise? Apply your education, that's what you're spending the big bucks for.
 
JPINFV said:
You're a student at Wash U and have fallen into the trap of every patient gets O2 unless explicitly ordered otherwise? Apply your education, that's what you're spending the big bucks for.
Click to expand...
Thank you. I was trying to find a nice way to say that since I happen to think Wu is a nice kid....
 
I would only say it's contraindicated if your patient is on fire... :unsure:
 
You must log in or register to reply here.
Back
Top