Topics

Oxygen Therapy CPG

Nasal cannulae / prongs
Hudson mask
Non-rebreathing mask
Humidified oxygen therapy
– Standard flow nasal oxygen
Jo Molloy and Naomi Pratt – High flow nasal oxygen
Critical Care Liaison Nurses

Nasal Cannulae / Prongs Face / Hudson Mask

Indications Indications
Supplemental oxygen flow of 1 - 4 litres/min Supplemental oxygen flow of 5 - 15
required to achieve desired oxygen litres/min required to achieve desired
saturation. oxygen saturation.

Oxygen flow
1 2 3 4 Oxygen flow
l/min 5 6 8 15
Approx FiO2 l/min
0.23 0.25 0.27 0.30 Approx FiO2
0.35 0.40 0.45 0.50

Humidified Oxygen
Non-Rebreathing Mask
Therapy
Indications
Supplemental oxygen flow of 10 - 15
litres/min required to achieve desired
oxygen saturation.
A non-rebreathing mask should be used
only in acute clinical deterioration, not
as a standard oxygen therapy device.
Oxygen flow
15
l/min
Approx FiO2
>0.70

1
Humidified Oxygen Humidification via face or
Therapy tracheostomy mask
Humidity is the amount of water vapour in a
gas.
The amount of water vapour a gas can hold
varies with temperature.
Warming the gas increases its capacity to
hold water vapour.
Supplemental oxygen for longer then 12 -
24 hours requires humidification via Fisher
and Paykel MR810 (or in ICU/ED MR850).

Humidification via face or Humidification via face or

tracheostomy mask tracheostomy mask
1. Slide the humidification chamber onto the humidifier and remove the
blue caps.
2. Hang the water bag, unwind the water feed set and spike the bag.
3. Connect the elbow of the breathing circuit to the chamber.
4. Attach the air entrainer to the other port on the chamber.
5. Attach the flow source to the air entrainer.
6. Ensure the blue port caps are inserted at both ends of the breathing
circuit.
7. Insert the cloverleaf heater wire adaptor into the cloverleaf socket on
the breathing circuit elbow above the chamber.
8. Turn the humidifier on and set as appropriate.
9. Attach interface

Standard Flow Nasal Oxygen / High

Humidification via face or Flow Nasal Oxygen / Tracheostomy
tracheostomy mask Direct Connection Device
Patients who require humidification

Not suitable for patients who have

high oxygen or flow requirements

Nasal interface CANNOT be used with

venturi device

2
Standard Flow Nasal Oxygen / High
Flow Nasal Oxygen / Tracheostomy
Standard Flow Nasal
Direct Connection Device Oxygen
1. Slide the humidification chamber onto the humidifier and
remove the blue caps.
2. Hang the water bag, unwind the water feed set and spike the
bag.
3. Connect the elbow of the breathing circuit to the chamber.
4. Attach the double flow adaptor to the other port on the
chamber.
5. Attach the flow source to the double flow adaptor. If using
one flow source only, ensure the port cover is secure on the
unused port.
6. Ensure the blue port caps are inserted at both ends of the
breathing circuit.
7. Insert the cloverleaf heater wire adaptor into the cloverleaf
socket on the breathing circuit elbow above the chamber.
8. Turn the humidifier on.
9. Attach interface.

Standard Flow Nasal

High Flow Nasal Oxygen
Oxygen
% Oxygen Oxygen flow Air Flow Total flow
30 2 15 17
40 5 15 20
50 9 15 24
60 15 15 30
70 15 9 24
80 15 5 20
Any patient who acutely requires supplemental O2 ≥
50% requires a Medical review +/-Critical Care Liaison
Nurse referral +/- MET call if meets criteria.

High Flow Nasal Oxygen High Flow Nasal Oxygen

It is recommended those patients who The only difference in the set up

require high flow nasal oxygen are
managed in clinical areas where staff
are trained in the management of this
therapy
– E.G. Intensive Care Unit, Coronary Care
Unit, Emergency Department, & Ward
5FN.
between high flow and standard flow
nasal oxygen is the wall oxygen and
air flow meters
Where possible patients should be
managed in the most appropriate
clinical area for their needs, especially
if it relates to end of life care.

3
High Flow Nasal Oxygen Percentage of Oxygen
% Oxygen 30 Litres flow 40 Litres flow 50 Litres flow
Oxygen Air Flow Oxygen Air Flow Oxygen Air Flow Increase or decrease the percentage of
flow flow flow
oxygen administered to each patient
30 3 27 5 35 6 44
to obtain recommended O2Sats as per
40 7 23 10 30 12 38
50 11 19 15 25 18 32
Oxygen CPG (or as prescribed).
60 15 15 20 20 25 25
70 19 11 25 15 32 18 – 94 - 98% for acutely hypoxic patient
80 22 8 30 10 38 12 – 88 - 92% for COPD or known CO2 retainer
90 26 4 35 5 44 6

Any patient who acutely requires supplemental O2 ≥

50% requires a Medical review +/-Critical Care
Liaison Nurse referral +/- MET call if meets criteria.

References
1. Barwon Health Centre for Education & Practice Development,
in Conjunction with ICU Liaison Nurses 2000 Learning
Resource & Procedure Package – Oxygenation &
Humidification.
2. Calvano, T.P., Sill, J.M., Kemp, K.R. & Chung, K.K. 2008 Use
of a High-Flow Oxygen Delivery System in a Critically Ill
Patient with Dementia. Respiratory Care. Vol 53. No.12
pp1739-1743.
3. Fisher and Paykel, MR850 Respiratory Humidifier Operating
Instructions
4. Groves N. & Tobin, A. 2007 High flow nasal oxygen
generates positive airway pressure in adult volunteers.
Australian Critical Care Vol 20, pp126-131
5. NHS National Institute for Clinical Excellence 2004 Clinical
Guideline – Chronic obstructive pulmonary disease.
www.nice.org.uk
References
6. O’Driscoll, B.R., Howard, L.S. & Davision, A.G. on behalf of the
British Thoracic Society. 2008 BTS guideline for emergency
oxygen use in adult patients. Thorax Vol63(suppl VI) vi1-vi68.
7. Ricard J.D. & Boyer, A. 2009 Humidification during oxygen
therapy and non-invasive ventilation: do we need some and how
much? Intensive Care Medicine. 35:963-965
8. SIGN Scottish Intercollegiate Guidelines Network 2009 British
Guideline of the Management of Asthma – A National Clinical
Guideline. www.sign.ac.uk
9. Tiep, B, Barnett, M. 2002 “High Flow Nasal vs High Flow Mask
Oxygen Delivery: Tracheal Gas Concentrations through a Head
Extension Airway Model”, Resp Care; 47: 1079
10. Tiruvoipati R, Lewis D, Botha J. 2008 A Comparison of High Flow
Nasal Oxygen with Face Mask Oxygen in Extubated Patients.
Australian Critical Care Vol 21. Issue 1. p71
11. Turnbull. B. 2008 High-flow humidified oxygen therapy used to
alleviate respiratory distress. British Journal of Nursing Vol17. No
19 pp1226-1230.