Standard Operating Procedure 14 (SOP 14)

Oxygen Therapy for Children

Why we have a procedure?

The following clinical procedures provide nurses, support workers and the carers of children
requiring oxygen therapy with a framework that promotes safe, consistent practice and enables
the appropriate support and guidance within the community setting. The procedures will be
followed to ensure the safe and appropriate administration of oxygen, handling, storage,
transportation of oxygen cylinders or concentrators and ancillary equipment of oxygen

What overarching policy the procedure links to?

Operational policy

Which services of the trust does this apply to? Where is it in operation?

Group Inpatients Community Locations

Mental Health Services   
Learning Disabilities Services   
Children and Young People Services   all

Who does the procedure apply to?

These procedures and guidance apply to all BCPFT staff and staff working on
behalf of the trust caring for children requiring oxygen therapy.

When should the procedure be applied?

Oxygen therapy may be required to support the health and development of children with altered
respiratory function or an artificial airway in situ. Oxygen administration may also be required in
an emergency or resuscitation situation. The requirement for oxygen therapy will depend on the
child’s individual needs, as assessed by their GP or Hospital Consultant and as documented in
their individualised care plan.

How to carry out this procedure (step step-by-step information)

 Methodology and procedures.

PROCESS

Caring for an oxygen or technology dependent child has a significant impact upon
family life, it is important when caring for such children, to minimise family distress,
promote family functioning and promote the health and development of the child.
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 Not all oxygen dependent children are monitored. If the child is to be monitored, staff
should be aware of the monitoring procedure and individualised care plan
guidelines, in relation to oxygen administration and oxygen saturation levels. The
referring medical practitioner should inform BCPFT of the parameters of use.
A specialist oxygen company called Baywater provides equipment to the service user’s
home they will also provide and maintain the equipment/Oxygen supports combustion
so must be used with care. The carers should be proved with written safety
information by Baywater
Every child requiring oxygen therapy will have an individualised care plan. This will
provide details as directed by the prescriber (GP or Consultant) and Baywater
regarding:

 The amount of oxygen required (litres/minute).

 A sliding scale of parameters indicating when to seek advice and who to contact.

 The mode of delivery and system required.

 Equipment to be used.

New care plans will be formulated as required, should the child’s needs alter due to
changes in his/her condition
The oxygen cylinder or concentrator will have pre-set parameters as per prescription
by a qualified practitioner

If weaning from oxygen therapy is appropriate, this will be supervised and the
baby’s/child’s progress must be monitored by nursing staff. Staff will follow Standard
Operating Procedure 21 (SOP 21) Sleep Study in Children.
The procedure for supporting the administering the prescribed oxygen therapy
should be discussed and understood by the carers and preferably the child too.
Informed consent to treatment should be determined verbally, for each procedure,
from both the carers and preferably the child too.
All ancillaries and equipment should be used in accordance with Baywater
recommendations and provision. Masks that are visibly soiled can be washed in
soap and water and dried thoroughly before continuing use.
Equipment should be decontaminated or changed as per the manufacturers
Guidance and should be disposed of in clinical waste bags. Humidified oxygen
guidance will differ from that of normal oxygen; refer to manufacturer’s guidance for
direction.

The following procedure for commencing oxygen therapy should be followed:

ACTION RATIONALE

Oxygen is a drug and must be used as To prevent the harmful effects of

prescribed. inappropriate usage.

Once prescribed, Baywater currently

provide and take responsibility for all
oxygen and oxygen therapy equipment,
to be provided direct to the service user
As soon as the child has been To assist with communication between
discharged, on home oxygen is a professionals involved in care and
possibility, referral to the team should be empower carers/support workers.
sought.
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 Discharge planning meetings and To ensure continuity of care and
checklists facilitate this promote the best interests of the child
and their carer.

The team will liaise with professionals To ensure continuity of care and
and agencies involved in the care of the promote the best interests of the child
child. and their carer.

The team will ensure that prior to To identify and reduce the risks of harm
discharge, a risk assessment has been related to the use of oxygen therapy.
completed either by Baywater or
clinicians at the hospital to ensure safe
use of oxygen, within the home.
The team will ensure all equipment is To ensure a smooth transition of care
supplied to the service user’s home by from the hospital to the home.
Baywater, and should be set up prior to
discharge and will liaise with the hospital
to ensure a smooth discharge.
The team will support carers/support To assist with communication and
workers and ensure they understand the empower carers/support workers.
child’s condition and reason for therapy.
Prior to commencement of a health
intervention, the Professional must
check the amount of oxygen in the
cylinder. If deemed insufficient, they
should contact Baywater for an
emergency supply.
The team will ensure carers/support To ensure the child’s safety and support
workers are competent and happy to use carer/support workers.
all necessary equipment and patient
specific competencies will be completed.
Liaise with Baywaater for any necessary
additional support or training.
The CCN/palliative care team will check To empower carers/support workers to
that all carers/support workers assess the child’s condition.
understand how to assess their child’s
respiratory function.
If monitors are provided, carers should To promote the health and safety of the
be familiar with their use and the action child
to be taken, should alarms go off.
As part of acute trusts discharge To promote the health and safety of the
planning, it is expected that carers child. To support the carers if their child
should be provided with resuscitation deteriorates and required hospital
training, and receive any updates and admission.
information if necessary.
Staff/child/carers will be able to calculate To promote the well-being of the child.
the length of time a portable oxygen
cylinder will last, they will need to liaise
with Baywater for further supplies and
have a plan of action should oxygen not
be available.
The CCN/palliative care team will take To ensure efficient use of resources.
responsibility for informing the child’s
GP, when oxygen is removed from the
home.
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The following EQUIPMENT is required for oxygen therapy, but may vary according to the
individual needs of the child:
.

 Oxygen concentrator.
 Prescription and/or Home Oxygen Order Form

 Back-up oxygen cylinder(s).

 Portable oxygen cylinder in carry-bag.

 Flow meter.

 Face or tracheostomy mask.

 Nasal cannulae.

 Disposable oxygen tubing.

 Humidification equipment.

 Sterile water.

 Saturation monitor and probes or apnoea monitor if recommended.

 Duoderm/mefix or alternative dressing for fixation of nasal cannulae.

The following procedure for SAFE HANDLING of oxygen should be followed:

ACTION RATIONALE

BCPFT must ensure that either Baywater Oxygen supports combustion so nursing
or/and acute trust have supplied both the staff/the child/carers or support workers, as
child/carers with written safety information. appropriate, must be aware of the potential
fire risk and how to avoid this.

An assessment of the home To facilitate safe use of oxygen

environment should be undertaken and decrease the risk of harm
by Baywater, prior to the child being associated with its use.
discharged from hospital. A copy of the template risk
It may be appropriate to check that .
Baywater have informed utility
companies, the fire brigade, home
and car insurance companies of
the presence of oxygen.
There must be access to a
telephone, in case of an emergency.
Both the child/carers will be trained To ensure safety of the child and family
in the use of all necessary
equipment by Baywater.
The CCN/palliative care team will support
them both in competence and
confidence to use the equipment.

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Carers will take responsibility for
the correct storage of cylinders
and equipment following initial
advice and training from Baywater.
Maintenance is the responsibility of
Baywater.
Equipment servicing will be carried
out as necessary by Baywater.
Emergency telephone numbers will be
supplied to the carers and information for our
of hours.
To ensure equipment is
appropriately maintained and
empower carers in the care of
their child.
To ensure safe operation of
equipment.
To support the carers at home
and ensure they have immediate
access to information.

Safety Guidance: BCPFT staff and carers should adhere to the following:

 Wash hands before use.

 Close the cylinder valve after use.

 Smoke alarms should be installed in the home. These should be tested monthly.

 Do not use oxygen near a naked flame or fire.

 DO NOT SMOKE near oxygen.

 Ensure rooms in which oxygen is used, are well ventilated.

 Do not use aerosols near oxygen.

 Use electrical equipment with care near oxygen.

 Do not allow children to play with equipment.

 Do not allow untrained staff or carers to use equipment.

 Keep cylinders free of dust and dirt.

 Do not hang clothing or other items on oxygen equipment.

 Do not use oil or grease on valves or connectors.

 Do not use Liquid paraffin based products on patient due to fire risk.

 Store cylinders preferably inside, upright and away from heat or cold and flammable
liquids. Cylinders expire three years from filling date.

 Where practical, store oxygen cylinders near an exit, to facilitate rapid removal in
emergency situations. If possible indicate where oxygen is stored.

 Return all empty oxygen cylinders to Baywater who will collect and replace as
necessary.

Safe Transportation of Oxygen Cylinders: BCPFT staff and carers should adhere to and advise
the following:

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  Always consider whether a cylinder needs to be transported at all. Oxygen
administration outside the home, via a portable cylinder may be required to promote
mobility and social inclusion.

 No more than two cylinders should be carried at a time.

 Cylinders must be checked for leaks before the journey commences.

 Cylinders should be secured. Free movement may result in damage to the cylinder
or present a hazard to the occupants of the vehicle.

 Cylinders should be stored out of direct sunlight.

 DO NOT SMOKE in a car carrying oxygen cylinders.

 Vehicle windows should be partially open to provide ventilation.

TRAINING AND COMPETENCIES

All healthcare professionals and support workers involved in the care of children
requiring oxygen therapy have a personal responsibility and accountability to ensure that
they are trained in infection prevention, including hand decontamination and have completed
competencies set out by BCPFT.
The CCN/palliative care team or other relevant/specified team is responsible for
ensure that the individual child requiring oxygen therapy and/or their carer has received
instruction from Baywater and that they feel competent to administer oxygen therapy. This
should be documented.
Risk assessments should be carried out if there is a significant hazard identified.
These should be carried out by a trained, experienced and competent member of staff.
The child and/or carer should take full responsibility for routine administration of
oxygen therapy. Follow up training and ongoing support is available for service uses, carers
and support workers, for the duration that oxygen therapy is required through the
CCN/palliative care.
The Children’s clinical lead in conjunction with the CCN/palliative care team
leader is responsible for reviewing the content of these procedures and for
monitoring compliance including training requirements
.
TRAINING AND COMPETENCIES
The care of the child requiring oxygen therapy isn’t an extended role however, additional
training may be beneficial. Oxygen should only be administered by nurses, support workers
and carers who have received appropriate training and been assessed as competent.
Training should be accessed from a recognised provider, for example, Baywater. Regular
updating of knowledge is essential and should be undertaken every three years minimum,
to maintain competency. The team leader must ensure that relevant competency
documents have been completed before nursing staff can care for a child requiring oxygen
therapy. Nurses must understand their responsibilities and carry out drug administration in
line with standards for medicines management (NMC 2010).

Competency should be discussed/reviewed as part of the annual KSF review.

All healthcare professionals and support workers should have basic life support training
every year. Family members caring for a child on oxygen therapy, should have initial basic
life support training before being discharged home.
All staffs are expected to ensure that service users and their carers benefit from care
that is focused upon respect for the individual.

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Associated Documents
Opearational policy
Medical devices policy
Standard Operating Procedure 21 (SOP 21)
Sleep Study in Children

Equality Impact Assessment

Please refer to overarching policy

Data Protection Act and Freedom of Information Act

Please refer to overarching policy

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Unique Identifier for this SOP is BCPFT-CYPF-SOP-OP-14

State if SOP is New or Revised New

Policy Category Children’s Services

Executive Director
Director of Nursing, AHPs and Governance
whose portfolio this SOP comes under
Policy Lead/Author Team Leader, Community Paediatric Specialist
Job titles only Team
Committee/Group Responsible for
CYPF Quality and Safety Group
Approval of this SOP
Month/year consultation process
n/a
completed
Month/year SOP was approved June 2018

Next review due June 2021

Disclosure Status ‘B’ can be disclosed to patients and the public

Review and Amendment History - to be completed by Corporate Governance

Version Date Description of Change

1.0 June 2018 New SOP for BCPFT used to be a Policy

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