As the time drew closer and closer for Nathan's discharge from the NICU, we became more and more proactive in Nathan's care. The only thing really keeping Nathan in the hospital at this point was his need for extra oxygen support and training that we required on how to care for Nathan once he was home.
At this point Nathan was still on a high-flow oxygen support. When a patient is on high-flow, the nurse or doctor is able to control both the rate (the amount of supplemental oxygen support being given in liters per minute) and the percentage of oxygen (vs. "room air") that the patient receives through the nasal cannula.
So for example, Nathan was on 2 liters of support with a mixture of 50% oxygen and 50% room air. It seems that protocol is to wean the percentage of oxygen to at least 30% before they start to lower the rate. However, in Nathan's case, when they tried to lower the percentage, he did not tolerate the change. So they would raise the rate to compensate for the change in percentage. Then when they tried to lower the rate, they would have to raise the percentage again. It was very, very frustrating and seemed like a never-ending battle.
And in my head it seemed entirely illogical. We had been told that Nathan could come home on a low-flow oxygen system. On low-flow, you are unable to adjust the percentage of oxygen being given. It is always 100% pure oxygen. The only thing you are able to adjust is the rate.
So in my head, it seemed entirely logical that we should put Nathan on a low-flow system at 100% oxygen and then just work down the rate of support. And for Nathan to be able to come home, that rate needed to be less than 1 liter. Ideally, they wanted it to be around a 1/2 liter.
So I mentioned my brilliant plan to the day nurse. Unfortunately, she wasn't one of Nathan's regular nurses and didn't respond as favorably as I was hoping. She just said that she would leave a note for the doctor about it. As you can probably guess, I was more than disappointed in her reaction. I was expecting her to agree that it was a brilliant idea, call for the doctor, for him to agree that it was brilliant, and then for the change to take place.
Since that didn't happen, we decided to wait until the night nurse came on and try again! The night nurse, Bonnie, happened to be one of Nathan's primary care nurses, and one of our favorites. So believing that we would get a better response from her, I brought it up again, going over Nathan's ups and downs on the high-flow and our idea with the low-flow.
Cha-ching! Bonnie, agreed that it was a great idea and worth trying. So within an hour or so, she had contacted Dr. Yoder, who agreed that it was worth a try. So within a couple of hours Nathan was on low-flow and doing great!
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