1319824

6.
GUIDELINE /PROCEDURE
SUBJECT:
OXYGEN THERAPY AND DELIVERY DEVICES FOR

PAEDIATRICS JHCH (Excluding NICU, ED, ICU)
DOCUMENT NUMBER:
6.6
DATE DEVELOPED:
June 2006
DATES REVISED:
November 2011, August 2012
DATE APPROVED:
August 2012
REVIEW DATE:
August 2016
DISTRIBUTION:
JHCH H1, J1, J2A, J2Day Stay, Oncology Day Stay
PERSON RESPONSIBLE FOR MONITORING AND REVIEW:
Paediatric Respiratory CNC
COMMITTEE RESPONSIBLE FOR RATIFICATION AND REVIEW:
Kaleidoscope GNS Quality Committee
Keywords:
children, device, oximetry, oxygen, therapy, SaO2
Disclaimer:
It should be noted that this document reflects what is currently regarded as a safe and appropriate approach
to care. However, as in any clinical situation there may be factors that cannot be covered by a single set of
guidelines, this document should be used as a guide, rather than as a complete authorative statement of
procedures to be followed in respect of each individual presentation. It does not replace the need for the
application of clinical judgment to each individual presentation.
SAFE WORK PRACTICE
Oxygen Guideline July 2012

Approved on: July 2012
Page 1 of 42
SAFE WORK PRACTICE
1. Oxygen is highly combustible; therefore anything that supports or initiates

combustion should be avoided e.g. smoking, candles.
2. All electrical equipment, wall oxygen and cylinder oxygen will be operated within the
guidelines of safe work practices for both patient and staff.
3. All oxygen delivery circuits are single patient use as per infection control guidelines.
TABLE OF CONTENTS:
DEFINITIONS / ABBREVIATIONS ................................................................................... 4
1.
OUTCOMES............................................................................................................. 5
2.
INDICATIONS .......................................................................................................... 5
3.
PRECAUTIONS ....................................................................................................... 5
4.
OXYGEN THERAPY PROCEDURE ......................................................................... 6

4.1 OBSERVATIONS ............................................................................................. 6
4.1.1 SIGNS AND SYMPTOMS OF RESPIRATORY DISTRESS ................... 7
4.1.2 OBSERVATION TO ASSESS THE SIGNS AND SYMPTOMS OF
RESPIRATORY DISTRESS .................................................................. 8
4.1.3 NORMAL RANGES IN BLOOD GAS ANALYSIS ................................... 9
5.
NURSING CARE FOR ALL CHILDREN ON OXYGEN THERAPY ........................... 10
6.
DELIVERY SYSTEMS .............................................................................................. 11

6.1 NASAL CANNULA ............................................................................................ 11
6.1.1 NASAL CANNULA PROCEDURE ......................................................... 12
6.1.2 ADDITIONAL NURSING CARE FOR NASAL CANNULARS ................. 12
6.2 NASAL CANNULA WITH WARMED HUMIDIFIED OXYGEN (WHO) VIA THE
FISHER & PAYKEL HUMIDIFICATION SYSTEM ................................................ 13
TABLE 1: F & P HUMIDIFIER CURCUITS, CORRESPONDING PRONGS &
USE .................................................................................................. 14
6.2.1 WARMED HUMIDIFICATION ................................................................ 15
6.2.2 WHO EQUIPMENT ................................................................................ 16
TABLE 2: F & P BC RANGE NASAL CANNULA SIZE SELECTION TO USE
WITH CIRCUIT RT329 INFANT RESPIRATORY CARE SYSTEM .... 17

Page 2 of 42
TABLE 3: F & P OPTIFLOW JUNIOR NASAL CANNULA SIZE SELECTION TO

USE WITH CIRCUIT RT330 OPTIFLOW TUBING KIT ..................... 17
6.2.3 ASSEMBLE WHO EQUIPMENT ............................................................ 17
TABLE 4: WHO PROCEDURE ......................................................................... 19
6.2.4 ADDITIONAL NURSING CARE FOR CHILDREN ON WHO VIA NASAL
CANNULAE ........................................................................................... 28
6.2.5 TRANSPORTING CHILD WHILE ON FISHER & PAYKEL WHO
CURCUIT .............................................................................................. 29
TABLE 5: PROCEDURE FOR TRANSPORT ................................................... 29
6.2.6 CLEANING WHO ................................................................................... 30
6.2.7 TROUBLESHOOTING FOR WHO ......................................................... 30
6.3 FACE MASK ..................................................................................................... 31
6.3.1 PROCEDURE FOR FACE MASK APPLICATION .................................. 31
6.4 PARTIAL RE-BREATHER ................................................................................ 32
6.4.1 PARTIAL RE-BREATHER PROCEDURE .............................................. 33
6.5 NON RE-BREATHER BAG .............................................................................. 33
6.5.1 NON RE-BREATHER BAG PROCEDURE ............................................ 33
6.6 VARIABLE CONCENTRATION MASK ............................................................. 34
6.6.1 VARIABLE CONCENTRATION MASK PROCEDURE ........................... 35
6.7 BLOW OVER OXYGEN.................................................................................... 35
6.8.1 BLOW OVER OXYGEN PROCEDURE ................................................. 35
6.8 TRANSPORT OXYGEN VIA PORTABLE CYLINDER ...................................... 36
7.
WEANING ................................................................................................................ 36
8.
EQUIPMENT CHECK ............................................................................................... 37
9.
DOCUMENTATION .................................................................................................. 37
DEPARTMENT OF HEALTH CIRCULARS ...................................................................... 38

AREA POLICIES .............................................................................................................. 38
AUTHOR & CONSULTATION .......................................................................................... 38
REFERENCES ................................................................................................................. 39
APPENDIX 1. DETERMINING FiO2 DELIVERED FROM THE OUTLET FLOW ............... 40
APPENDIX 2. AIR / OXYGEN BLEND FOR WHO ........................................................... 41

Page 3 of 42
DEFINITIONS / ABBREVIATIONS:
BP
Blood pressure
BTF
Between the Flags
CXR
Chest x-ray
ED
Emergency Department
FiO2
Fraction of inspired oxygen (%)
HR
Heart rate
HFNP - 8
High-flow nasal prong to 8 L/min limit
ICU
Intensive Care Unit
IV or IVT
Intravenous Therapy
JHCH
John Hunter Childrens Hospital
LOC
Level of consciousness
L/kg
Litres of gas flow per kilogram of body weight per

minute
L/min
Litres of gas flow per minute
NBM
Nil by mouth
NICU
Neonatal Intensive Care Unit
NPA
Nasopharyngeal Aspirate
MO
Medical Officer
O2
Oxygen
PaO2
Partial pressure of oxygen in arterial blood
Resps
Respiratory rate
RDS
Respiratory Distress Score
RR
Respiratory rate
SaO2
Oxygen saturation
SOP
Standard Operating Procedure
SPOC
Standard Paediatric Observation Chart
WHO
Warmed Humidified Oxygen

Page 4 of 42
1. OUTCOMES:
To maintain adequate oxygenation to body tissues to ensure:
1. Hypoxia is minimised
2. Optimal respiratory status is achieved and maintained.
3. Safe and effective administration of oxygen is delivered.
NOTE:
In order to increase the fraction of inspired oxygen concentration (FiO2) available to

a patient, a variety of oxygen delivery devices are employed to administer medical
oxygen. The oxygen should be administered with humidity if possible.
Oxygen is a drug and should be given only when ordered by a medical officer, or by
a registered nurse as a nurse initiated order in an emergency situation. A nurse
initiated order for oxygen can be given as an intervention whilst patient is reviewed.
Oxygen is to be ordered on the intervention section of an age appropriate Standard

Paediatric Observation Chart (SPOC).
Oxygen therapy is given to maintain oxygen saturations above 95% unless altered
calling criteria are documented on the SPOC.
2. INDICATIONS:
Hypoxia.
Increased work of breathing, increased heart rate with progressive decrease in

SaO2.
3. PRECAUTIONS:
In patients with chronic carbon dioxide retention whose stimulus to breathe is a

decreased partial pressure of oxygen in arterial blood (PaO2), oxygen
administration may depress respiratory drive. Careful monitoring of these patients
for hypoventilation is required during oxygen therapy1.
Persons with severe lung disease need to be maintained at the prescribed oxygen
saturation range.

Page 5 of 42
4. OXYGEN THERAPY PROCEDURE:

4.1
OBSERVATIONS:
Childrens oxygenation status should be assessed in a well-lit room if possible by
assessing clinical signs and symptoms and recording baseline observations.
Observations must be recorded on an age appropriate NSW Health Standard

Paediatric Observation Chart (SPOC) with the times entered as the observations
are completed.
The response of the nurse assessing the child will depend on the clinical
assessment, level of deterioration and which zone the observations are recorded in.
See Kaleidoscope Recognition of the Deteriorating Paediatric Patient Guideline,
Number 3.19.
In the acute presentation, frequent observations should be attended and recorded.

The first set of observations must be initiated within 10 minutes of the childs
deterioration then half hourly to hourly depending on the condition of the child2.
Patients who are stable with ongoing treatment of oxygen need hourly heart rate,
respiratory rate, SaO2, and gas flow. Temperature and BP can be attended fourth
hourly if child stable.

Page 6 of 42
4.1.1 SIGNS AND SYMPTOMS OF RESPIRATORY DISTRESS:
Neurological Status
Anxiety
Restlessness initially progressing to

agitation, confusion, disorientation
and loss of consciousness.
Increased Work of Breathing
Apnoea
Change in pattern of breathing including;

respiratory rate, rhythm and effort.
Vital Signs
Nasal flaring
Grunting
Mouth breathing
Use of accessory muscles and recession
Tachycardia
Hypertension
Tachypnoea
Bradypnoea may indicate further

deterioration
Skin Colour
Decreasing O2 saturation
Mild hypoxia initially as pale colour due to

peripheral vasoconstriction.
Clammy
Later signs progressing to bluish grey

[cyanosis] most easily seen as lip
discolouration3.

Page 7 of 42
4.1.2 OBSERVATIONS TO ASSESS THE SIGNS AND SYMPTOMS OF

RESPIRATORY DISTRESS INCLUDE:
a)
Respiratory rate.
b)
Respiratory effort and work of breathing as above.
c)
Heart rate.
d)
SaO2 (in any amount of O2).

An oximetry reading:
95% in room air is desirable unless an altered calling criterion is

documented on the SPOC.
90-95% indicates a need for increased observation and report to the

nurse in charge as per SPOC zone protocol.
< 90% requires a rapid response as per SPOC zone protocol.
The response to the SaO2 reading is dependent:
On the childs normal baseline observation. Children with chronic

illnesses such as congenital heart disease, chronic obstructive pulmonary
disease, pulmonary hypertension, cystic fibrosis and bronchopulmonary
dysplasia should be assessed individually as their oxygen requirements
may be different. An altered calling criterion will need to be documented
on the SPOC if a childs stable baseline observations are outside the
accepted values.
On work of breathing and heart rate and not just a decrease in SaO2
alone.
e)
Oxygen Flow rate of gases and device.
f)
Capillary refill.
g)
Blood pressure.
h)
Level of consciousness.
i)
Pain score.
j)
Temperature.
k)
Blood glucose level if necessary.

Page 8 of 42
4.1.3 TABLE 1: NORMAL RANGES for ARTERIAL BLOOD GAS 4

Measurement
Arterial
Blood
Clinical Notes
Acid-base status
(pH)
7.35 7.45
Most important acid-base value; detects

acidosis or alkalosis
Partial pressure
of carbon dioxide
(PaCO2)
35 45
mm Hg
Measures adequacy of ventilation and

respiratory contribution of acid-base
abnormality (respiratory acidosis)
Partial pressure
of oxygen (PaO2)
(sea level)
80 100
mm Hg
Indicates driving pressure that causes oxygenhemoglobin binding; varies with age and
barometric pressure.
Bicarbonate
(HCO3)
21 28
mEq/L
Measures metabolic contribution to acid-base

abnormality (metabolic acidosis); calculated
from pH and Pco2
Base excess (BE)
-2 to +2
Reflects deviation of bicarbonate concentration

from normal
Saturation of
hemoglobin with
oxygen (SaO2)
96 98%
Indicates abnormality of oxyhemaglobin

association and dissociation; may be
measured directly or calculated from Po2, pH
and body temperature

Page 9 of 42
5. NURSING CARE FOR ALL CHILDREN ON OXYGEN

THERAPY:
Oxygen is a drug and should be given only when ordered by a medical officer, or by
a registered nurse as a nurse initiated order in an emergency situation. A nurse
initiated order for oxygen can be given as an intervention whilst patient is reviewed.
Observations as above per guideline.
All children on oxygen therapy MUST be connected to the Massimo System
Patients who are stable with ongoing treatment of oxygen need hourly heart rate,
respiratory rate, SaO2, and gas flow. Temperature and BP can be attended fourth
hourly if child stable.
Oxygen therapy is given to maintain oxygen saturations above 95% unless an

altered calling criterion is documented on the SPOC.
Children who receive oxygen therapy via the Fisher and Paykel Humidifier at
a flow rate of 1L/kg/min with a ratio of oxygen to air of 1:1, which equates to
an approximate FiO2 of 60% oxygen, can be nursed in the paediatric wards of
JHCH.
Team leader should be notified BEFORE an increase in oxygen concentration

or flow rate is given.
A medical review should be attended after an increase in oxygen concentration or

flow rate is given.
Patient delivery device position is important as dislodgement will result in a loss of

respiratory support
If feeding is required, respiratory status should be observed closely
If child is NBM, IV fluid replacement or NG therapy should be commenced
Oral and nasal hygiene and normal saline drops as necessary.
Suctioning as required with caution. If suctioning is indicated there should be two

nurses with child for this procedure with emergency equipment ready to use
therefore checked prior to commencement of the procedure.
Document all changes in oxygen administration on the SPOC.
Oxygen is to be ordered on the intervention section of the SPOC.
Document all interventions on patients notes.
All other observations and interventions are to be documented on the paediatric

respiratory observation chart.

Page 10 of 42
6. DELIVERY SYSTEMS:
The choice of delivery system is to be determined by the rate of oxygen

required as calibrated against the clinical assessment of work of breathing,
heart rate, oximetry reading and the age of the child.
It is to be determined by flow rate and FiO 2 required (See Appendix 1)
The concentration of oxygen delivered is variable and depends on gas flow

rate, fit of the device, ventilatory pattern and anatomic dead space5.
The devices used to deliver oxygen are:

6.1 Nasal Cannulae
6.2 Nasal Cannulae with warmed humidified oxygen (WHO) via the
Fisher & Paykel Humidification System
6.3 Simple Mask
6.4 Partial Rebreather Mask
6.5 Non Rebreather Mask
6.6 Variable Concentration Mask (Venturi Or Air-Entrainment Mask)
6.7 Blow over oxygen
6.8 Transport oxygen via portable cylinder
6.1
NASAL CANNULA:
L/Min
FiO2
0.125 2
1L/min = 24% and 2L/min = 28%
Nasal cannulae from wall oxygen are the delivery method of choice for infants,
toddlers, older children and adolescents, who require a flow rate up to 2 L/min.
Nasal cannulae deliver a maximum of 28% FiO2. One litre of oxygen will deliver
approximately 24% FiO2 (See Appendix 1).
Do not deliver a flow rate greater than 2 L/min from wall oxygen as it is
uncomfortable for the child. If a higher flow rate is required an alternate delivery
system should be considered.

Page 11 of 42
6.1.1 NASAL CANNULAE PROCEDURE:

1. Obtain the appropriate size nasal cannulae (ie infant, intermediate infant, child
or adult).
2. AQUAPAK humidifier is to be used when a child is having oxygen directly
from the wall. Attach AquaPakTM to the wall outlet.
3. Attach an appropriate (high, low or ultra-low flow) oxygen meter to wall oxygen
and ensure it is working.
4. Explain the procedure to the child and parents.
5. Assess adequacy of oxygen delivery via the childs nasal passages.
6. Clean nares as needed.
7. To minimise skin irritation place thick Duoderm on the cheeks before securing
the prongs to the face with Hyperfix. Measure and cut Hyperfix ready for use.
8. Attach the nasal prongs to the flow meter; adjust the oxygen flow to the required
amount of oxygen ordered.
9. Gently fit the prongs into the nostrils making sure the curves of the prongs follow
the contour of the nasal passage.
10. Ensure the tubing is under or over the childs ears and behind their head.
Anchor the tube by sliding the plastic ring up until the tubing is sitting
comfortably around the childs head.
11. Secure prongs to Duoderm with the premeasured Hyperfix. Nasal prongs should
be changed when necessary or at least weekly.
12. Connect child to Massimo System for continual monitoring
13. Check every four hours:
Integrity of nasal passages and skin area under prongs
The prongs are inserted into the nostrils correctly
Kinking or twisting does not obstruct the flow of oxygen.
6.1.2 ADDITIONAL NURSING CARE FOR CHILDREN ON WALL OXYGEN VIA

NASAL CANNULAE: (Also See Section 5 Nursing Care for All Children On
Oxygen Therapy)
A maximum of 2 L/ minute via nasal prongs. A higher flow may cause discomfort
for the child unless a Fisher & Paykel Humidification System is used.
If child is requiring more that 28%, wall oxygen delivery system needs to be
changed.
Nasal prong position is important as dislodgement will result in a loss of

respiratory support.

Page 12 of 42
Observe nares for drying, cracking or bleeding of nasal mucosa when attending
cares. Nasal toilets should be attended and normal saline drops as necessary
6.2 NASAL CANNULA WITH WARMED HUMIDIFIED OXYGEN (WHO) VIA

THE FISHER & PAYKEL HUMIDIFICATION SYSTEM
Each Fisher & Paykel Humidifier Circuit has its own corresponding set of nasal prongs.
The different circuits and nasal prongs are not interchangeable. There are three (3) circuits
that may be used at John Hunter Childrens Hospital. These circuits are to be used with
the MR850 heated humidifier. See Table 1 below:

Page 13 of 42
Table 1: Fisher & Paykel Humidifier Circuits, Corresponding Prongs and Use
Circuit
Prongs
Use
Gas Flow
FiO2
Weight
RT329 Circuit -
BC Range of
Prem infant Paediatric
2 8 L/min
Infant Respiratory
Cannula
Original circuit used at JHCH
Max 1L/kg/min
Care System
(See Table 2)
Circuit of choice for routine WHO
in ward
Dependent on gas
>5kgs
RT330 Circuit -
Optiflow
Premature infant Paediatric
1 20 L/min
flow which is made
1kgs
Optiflow Tubing
Nasal
New Circuit Released in June 2012
Max 20L/min
of oxygen / air
20kgs
kit
Cannula.
Used for patients on the Bronchiolitis HFNP WHO RCTrial
for children
blend. (See
(See table 3)
Can be used for sicker older children (up to 22kgs) needing flows
enrolled in
Appendix 2)
>8L/min in the ward
the trial
10 - 60L/min
Variable.
infant to
Maximum FiO2 is
RT203 Adult
Small,
This circuit is used in ICU and not generally in the ward.
Optiflow Circuit
medium and
If a bigger child is in need of flows >25L/min this system may be
60%, which equates
MaxVenturi
large adult
considered.
to a ratio of oxygen
Oxygen System
prongs.
The setup of this system is outside the scope of this guideline. See
and air of 1:1 can be
OPT542
HNE Health Guideline and Procedure: Humidified Oxygen Delivery via
nursed in paediatric
the MaxVenturi Oxygen Diluter with MR850 heated Humidifier in
wards
Intensive Care Adults)

Page 14 of 42
Prem
6.2.1. WARMED HUMIDIFICATION:
One of the complications of oxygen therapy, even for relatively short periods of
time, is the drying of the upper airway, which causes secretions to be thicker and
harder to expectorate 6, 7.
Humidification minimizes this inflammation, mucosal drying and retention of

secretions 6, 8.
When there is not enough humidity in the inspired gas, nasal passages become dry
and painful. There is also a higher risk of the development of atelectasis or
infection6, 8.
Oxygen is to be humidified for comfort of the infant or child using the Fisher &
Paykel Humidification system if possible.
Warmed humidification is advantageous during oxygen administration as cold, dry

inspired gas causes detrimental physiological changes within the airway such as
moisture and heat loss from the mucosa, airway secretions with decreased volume
and abnormal rheology, decreased mucociliary clearance, and inflammatory
reactions due to thermal injury or fluid imbalance 9. Additionally extra energy is
required to warm the gases in the airways.
Normal mucosal function is needed to maintain airway patency and lung

compliance9.
The inspired gas flows are heated to near body temperature (37.1) and are fully
saturated with water vapour10.
Warmed humidification oxygen / air flow is only used in conjunction with the Fisher
& Paykel MR850 Humidification System at present.
The Fisher & Paykel Humidification System is used at the discretion of the
nursing team leader and medical team.
The minimum and maximum gas flow rate through a Fisher & Paykel
Humidification system changes depending on the circuit and prongs used. See
Table 1 for Fisher & Paykel Humidifier Circuits, Corresponding Prongs and Use
Children who receive oxygen therapy via the Fisher and Paykel Humidifier at a flow
rate of 1L/kg/min with a ratio of oxygen to air of 1:1, which equates to an
approximate FiO2 of 60% oxygen, can be nursed in the paediatric wards of JHCH.

Page 15 of 42
A child can be transferred from Emergency Department to the ward if the child is
stabilised on WHO of 1L/kg/min with a ratio of oxygen to air of 1:1, which equates to
a FiO2 of 60% oxygen.
To calculate the flow rate of 1L/kg/min on the WHO, the childs weight will need to
be rounded up or down to the closest whole number. . For example a child weighing
3.3 kgs will be managed as a 3 kg child; an 11.8 kg child will be managed as a 12
kg child.
Children are NOT to be nursed in the wards if the gas flow rate exceeds 1 L/kg/min
with a ratio of oxygen to air of 1:1, which equates to a FiO2 of 60% oxygen unless
special precautions are initiated.
For babies <4kgs an oxygen analyzer is to be used with WHO.
The oxygen analyzer becomes less accurate when the gas flow decreases as air is
entrained diluting the oxygen concentration.
The oxygen analyzer is to be removed when gas flows are weaned as the reading
will be incorrect.
6.2.2 WHO EQUIPMENT
Fisher and Paykel provide three (3) humidifier circuits that are used with the Fisher
& Paykel Humidifier base (MR850).
Each humidifier circuit has its own corresponding prongs. Humidifier circuits and
prongs are not interchangeable.
Any of these circuits may be used in the JHCH wards.
The choice of circuit will depend on childs size, weight and flow requirements.
Ensure you have corresponding nasal prongs and circuit suitable to the childs
weight and flow requirements. See Table 1 for details.
If using Fisher and Paykel Optiflow nasal cannulae, Duoderm and Hyperfix are not
necessary as this product comes with adhesive (Wigglepad TM ) attached to the
prongs.
If the WigglepadTM adhesive is loose or does not adhere replace WigglepadTM.
DO NOT STICK OPTIFLOW NASAL CANNULAE TUBING TO FACE WITH

HYPERFIX.

Page 16 of 42
Table 2: FISHER AND PAYKEL BC RANGE NASAL CANNULA SIZE SELECTION TO

USE WITH CIRCUIT RT329 INFANT RESPIRATORY CARE SYSTEM 10
Cannula
Description
Minimum flow
Maximum patient flow
Code
BC2425
Premature
2L/min
(L/min)
6L/min
BC2435
Neonate
2L/min
6L/min
BC2745
Infant (term newborn)
2L/min
7L/min
BC2755
Intermediate infant
2L/min
7L/min
2L/min
8 L/min
(<5 kg)
BC3780
Paediatric
(> 5 kg)
Table 3: FISHER AND PAYKEL OPTIFLOW JUNIOR NASAL CANNULA SIZE

SELECTION TO USE WITH CIRCUIT RT330 OPTIFLOW TUBING KIT 11
The following codes should be used as per the current manufacturers instructions and
should be utilized as a guide when selecting nasal cannula.
Colour
Product
Item
Approx
Max Flow Rate
Wigglepad
Code
Weight Range
(L/Min)
Item Code
Premature Size
OPT312
<2kg
OPT010
Yellow
Neonatal Size
OPT314
1 8kg
OPT012
Purple
Infant Size
OPT316
3 15kg
20
OPT012
Green
Pediatric Size
OPT318
12 22kg
25
OPT012
Code
Red
6.2.3 ASSEMBLE WHO EQUIPMENT
Fisher & Paykel Healthcare Humidifier base (MR850) on IV stand.
Choose circuit and prongs appropriate to the childs condition, weight and flow
requirements.
o Fisher & Paykel Healthcare RT329 Infant Respiratory Care System.
Discard short piece of blue tubing as it is not used in the set-up.
o Appropriate size BC range nasal cannula. See Table 2: Fisher and Paykel
BC Range Nasal Cannula Size Selection.
OR
o Fisher & Paykel Healthcare RT330 Circuit - Optiflow Tubing Kit.

Page 17 of 42
o Appropriate size Optiflow nasal cannula. See Table 3: Fisher And Paykel
Optiflow Junior Nasal Cannula Size Selection To Use With Circuit RT330
Optiflow Tubing Kit.
Fisher & Paykel Temperature / flow probe (900MR868)
Fisher & Paykel Heater wire adaptor (900MR801)
One (1) piece of green tubing approximately 1m 1.3m long
Two (2) pieces of green tubing approximately 70cm long
Y connector
Analyzer if child weighs 3 4 kgs
Pathology bag to hold blue cap if analyzer is being used
1 litre bag of water for irrigation.
15L/min Oxygen flow meter x 2
15L/min air flow meter
Oximeter and appropriate size disposable probe. (See Kaleidoscope Guideline 6.4,
Paediatric Oximetry).
Ensure correct, functional emergency equipment (including suction catheters) are

available.

Page 18 of 42
TABLE 4: WHO PROCEDURE

Photos by HNE Health Medical Photography Department.
PROCEDURE
ADDITIONAL INFORMATION
EQUIPMENT REQUIRED.
Ensure you have corresponding nasal prongs

and circuit suitable to the childs weight and flow
requirements. (See Table 1, F & P Humidifier
Circuits, Corresponding Prongs And Use).
WHO Set ups can be assembled in advance

except for puncturing the water bag.
Set up in treatment room and not next to patient
RT329 Infant Respiratory Care

System
area
Not all children need an oxygen analyser

however smaller infants weighing 3 to 4 kgs
should have an analyser connected to the
humidifier.
The set up for both RT329 and RT330 are the same
RT330 Circuit - Optiflow

Tubing Kit.
CONNECT HUMIDIFIER BASE TO IV POLE:
Place Humidifier Base on metal bracket and

attach to the IV pole.

Page 19 of 42
FIT THE CHAMBER:
Depress the light blue finger guard above the

temperature readout.
Slide the water chamber onto the humidifier base.
HANG THE WATER BAG:
Hang the 1 litre water bag from the IV pole.
Remove the blue protector caps from top of water

chamber.
Unwind the waterfeed set from white storage

frame.
Spike the waterbag and water will automatically

feed into the chamber.
The bag should be at least 50cm above the

chamber.
50cm
between
bag and
chamber
CONNECT THE CIRCUIT:
DISCARD SHORT PIECE OF BLUE TUBING

from RT329 circuit set-up as it is not used.
Connect the elbow of the blue inspiratory circuit

to the chamber.

Page 20 of 42
Connect the yellow end of the heater wire

adaptor plug into the yellow socket on side of
machine.
Ensure the arrows on the plug line up with the

arrow on the machine.
Connect the 3 way plug of the heater wire

adaptor to the blue inspiratory circuit which has
been attached to the humidifier.
Connect the blue end of the temperature probe

into blue socket on the side of the humidifier.
Ensure the arrows on the plug line up with the

arrow on the machine.
Connect the middle plug of the temperature

probe into circuit on humidifier.
Be careful of the prongs as the temperature

probe is fragile and breaks easily.

Page 21 of 42
Connect the end of the temperature probe to
RT329 Circuit
the patient end of the circuit.
Hang circuit from IV stand to keep clean while

you continue with set up.
RT330 Circuit
Connect the white pressure manifold with 3

ports to the chamber. The ports are:
1. Top blue port is the pressure pop off
valve
2. The small middle nipple is a pressure
port for pressure lines, which we do not
utilize.
3. Lower port with blue cap is the oxygen
analyzer port.
DO NOT DISCARD THIS BLUE CAP IF REMOVED

(see below for instructions)
SET UP OXYGEN TUBING:
Take the two shorter pieces of green tubing

(approx. 70cm) and connect to the two top
sections of the Y connector.
Take the longest piece of green tubing (approx.

1m 1.3m) and connect to the lower end of the
Y connector.

Page 22 of 42
Take the longest piece of oxygen tubing which

is attached to the end of the Y connector and
connect it to the top of the white pressure
manifold.
Hang green tubing from IV stand to keep clean

while you continue with set up.
CONNECT NASAL CANNULA TO CIRCUIT:
If using RT329 Circuit connect
Push distal end of nasal cannula onto blue
a nasal cannula from the BC
inspiratory circuit.
size selection
If using RT330 Circuit connect

a nasal cannula from the
Optiflow Junior size selection.

Page 23 of 42
COMPLETE CIRCUIT:
RT329 Circuit
The humidifier may be turned on before it is

attached to wall gas outlets however the
humidifier will not reach its desired temperature
without gas flow.
RT330 Circuit
CONNECT HUMIDIFIER TUBING TO THE WALL

OXYGEN AND AIR SUPPLY:
Take humidifier to bedside.
Add a two way oxygen connector to the wall

oxygen meter before connecting green tubing.
This allows O2 high flow meter to be available
for emergency use.

Page 24 of 42
GAS FLOW:
Connect the two pieces of green tubing to the

oxygen and air flow meters.
Record the air and oxygen flows on the

paediatric respiratory observation chart.
POSITION OF HUMIDIFIER:
Do not set up the WHO under vents or in a

draught.
o
Cold air on circuit will cause increased

condensation11.
Ensure humidifier and chamber are positioned

lower than the patient.
o This allows any condensation to collect in
the tubing away from the patient.
TURN HUMIDIFIER ON:

The humidifier will take 10-15 minutes to reach
37.0C.
The humidifier needs flow from the wall to reach
desired temperature.
Humidifier must be warmed to at least 30 C before
connecting child to high flow. If the high flow gas is
cool and dry it is uncomfortable for the child.
The button on the right hand side of the humidifier
changes the mode. Keep the humidifier at the
default setting which is Invasive Mode. This is the
recommended setting to provide optimal
humidification for WHO.
Aim is to deliver optimal humidity 37C (44mg/L
H2O). Temperature readout on humidifier will
Page 25 of 42
fluctuate between 35-40C to achieve this.

SAFETY ALERT:
Do not touch the metal heater disk of the base unit
or the bottom of the humidifier chamber as both
become very hot and will burn if the unit is turned
on.
Ensure there is not excessive condensation (water
pooling) in the tubing or cannula. Check that the
tubes are not kinked or tangled.
ATTACHING AN OXYGEN ANALYSER:
An oxygen analyser should be used on infants
34 kgs.
Older children do not require an oxygen

analyser.
To attach an analyzer remove blue plug from

the lower port of the white pressure manifold.
DO NOT DISCARD BLUE PLUG.
Place blue plug in a pathology plastic bag and

attach to the IV stand for safe keeping so it can
be used again once analyser is removed.
Calibrate analyser to room air before placing

oxygen analyser sensor into port
Stand oxygen analyser on patient self
CONNECT CHILD TO WHO:

NOTE:
Connect child to Masimo System for continual

monitoring.
The nasal cannula size should be approximately

half the diameter of the nares (no seal should
be created).
Ensure at least a 2mm gap to the septum2.

Page 26 of 42
If an occlusive seal is formed between the

prongs and nares excessive pressure may be
generated2.
1. Gel hands.
2. Humidifier must be warmed to at least 30o Celsius
before connecting child to the gas flow as cool dry
gas is uncomfortable for child.
3. Explain the procedure to the child and parents.
4. Clean nares as needed.
5. If using the RT329 Circuit, the BC range of nasal
prongs will need to be taped to cheek.
6. Place a piece of thick Duoderm along each cheek.
(aids protection of skin from pressure) Measure
and cut Hyperfix ready for use.
7. If using the RT330 Circuit, the Optiflow range of
nasal prongs have tape already attached.
8. Remove the adhesive cover of the WigglepadTM
9. Ensure the gas flow is on
10. Ensure the prongs are the correct size for the age
of the child.
11. Gently fit the prongs into the nostrils making sure
the curves of the prongs follow the contour of the
nasal passage.
12. Secure prongs to Duoderm with the premeasured
Hyperfix or remove WigglepadTM backing and
secure to cheeks.
13. DO NOT STICK OPTIFLOW NASAL CANNULAE
TUBING TO FACE WITH HYPERFIX.
14. If the WigglepadTM adhesive is loose or does not
adhere replace WigglepadTM.
15. Ensure the tubing is under or over the childs ears
and behind their head.
16. Nasal prongs should be changed when necessary

Page 27 of 42
or at least weekly
17. Check every four hours:
Integrity of nasal passages and skin area under

prongs
Integrity of skin on face, ears and head from

metal ringed tubing if using Optiflow Junior
nasal cannula.
The prongs are inserted into the nostrils

Correctly.
Kinking or twisting does not obstruct the flow of

Oxygen10.
6.2.4 ADDITIONAL NURSING CARE FOR CHILDREN ON WHO VIA NASAL

CANNULAE: (Also See Section 6 Nursing Care for All Children On
Oxygen Therapy)
The minimum gas flow rate through a Fisher & Paykel RT329 Circuit is 2L/min and
maximum 8L/min.
The minimum gas flow rate through a Fisher & Paykel RT330 Circuit is 1L/min to a
maximum 20L/min.
The maximum gas flow rate for a child on the ward is 1L/kg/min.
The maximum oxygen flow rate for a child on the ward is 60%.
Hourly observation of circuit, water level and prong position
If the childs oxygen / air flow requirements increase beyond 1 L/kg/min of

flow or 60% oxygen the child needs urgent review +/- transfer to ICU
An oxygen analyzer is to be used on infants 3-4kgs
Be aware that if an oxygen analyzer is used on flows < 1L/kg/min, the read out may
be less accurate due to the child entraining air.

Page 28 of 42
6.2.5 TRANSPORTING CHILD WHILE ON WHO CURCUIT
To transfer paediatric patients within JHCH who are on WHO take humidifier with
patient.
Transfer the patient with the Fisher & Paykel MR850 turned off. This should be
done when transfer is imminent. The circuit will be warm enough to warm the
oxygen during the transfer. Transfer the patient with an oximeter with appropriate
alarm limits set, an ambu bag/mask, and emergency equipment as appropriate
TABLE 5: PROCEDURE FOR TRANSPORTING PATIENT ON WHO
Obtain an oxygen cylinder for transport and

check that it is full enough to support the
duration of transfer.
Check cylinder for appropriate flow meter

(capable of delivering 2L/min).
Disconnect the long piece of green tubing

from the bottom of the Y connector and
attach it to the flow meter on the oxygen
cylinder.
The end of this piece of tubing will remain

attached to the humidifier manifold for
transfer.
Set flow while flow meter is vertical.

Oxygen Cylinders may be laid on side with
flow meter always kept in upright position
to read accurately.
Adjust flow to 2L/min
Transfer child with Fisher & Paykel MR850

Page 29 of 42
6.2.6 CLEANING OF WHO
Each circuit, nasal prong and water supply line is disposable.
Y piece is re-usable alcohol wipe reuse oxygen tubing after cleaning with alcohol
wipes
For long term patients, change each circuit after 7 days.
Clean the humidifier base, small grey heater lead with yellow connectors, and stand
with large alcohol wipes after use.
Leads are thoroughly wiped over with alcohol wipes and re set up to decrease the
risk of cross infection and damage. The grey leads are not disposable.
Set up the unit for the next patient.
6.2.7 TROUBLESHOOTING FOR WHO
With the RT329 circuit, gas flows < 0.5 L/m may cause the humidification alarm to
be triggered increase the gas flow.
Temperature alarms triggered - The blue probes must be pushed into the circuit
carefully and completely in order to monitor the humidity and temperature in the
circuit. Ensure that the connections are firmly matched to each other. The humidifier
base will light up the area of concern on its diagram.
Also refer to Fisher & Paykel Healthcare Reference cards attached to the
humidifier unit.
Watch for rain-out in the clear prong tubing as this can cause a lavage into the
infant if tubing is raised above the level of the childs face. This may result in
aspiration.
Watch for condensation in the blue tubing. To remove the condensation from the
tubing, hold up the blue tubing above where you can see the condensation or the
pool of water forming and drain the fluid back into the water chamber.

Page 30 of 42
6.3 FACE MASK

L/Min
5 10
FiO2
45 60%
The face mask is applied over the mouth and nose. This increases the size of the
oxygen reservoir so that a higher flow rate can be administered.
Improper mask fit may allow room air to dilute oxygen concentration excessively
The vent holes in the mask allow room air to be inspired in addition to the oxygen
being delivered, and the exhaled carbon dioxide to be released.
A minimum gas flow of 5 L/min must be maintained in order to prevent

accumulation of carbon dioxide with subsequent re-breathing
For patient comfort, humidification should be used 6,12.
6.3.1 PROCEDURE FOR FACE MASK APPLICATION:

1. Obtain appropriate size mask and oxygen tubing.
2. Attach 15 litre flow meter to the oxygen outlet on the wall and ensure it is working
3. Explain procedure to the child and family.
4. Securely attach the oxygen tubing to the gas source and set the oxygen to the flow
rate required. (To determine the FiO2 that is being delivered from a flow rate see
Appendix 1).
5. Check for gas flow through the device before placing mask on patient.
6. Place the mask over the childs mouth and nose. Mold the metal strip on the bridge
of the nose portion of the mask to fit the patients face ensuring a snug fit to create
a seal.
7. Slip elastic strap over head and above or below both ears and adjust to ensure a
secure but comfortable fit. Gently pull the ends of the strap until the mask is secure
and comfortable
8. Observe child closely:
Connect child to Massimo System for continual monitoring
Continuous monitoring and hourly recording of childs work of breathing and

observations
Monitor childs compliance with mask.
9. Do not use for children who are vomiting or have excess secretions due to risk of
aspiration.
Page 31 of 42
10. If the patients oxygen requirements increase consider a partial re-breather or non
re-breather bag and mask.
6.4. PARTIAL RE-BREATHER

L/Min
6 - 15
FiO2
35 70%
The partial re-breathing bag is similar to the face mask but with the addition of an
oxygen reservoir bag and side ports.
By increasing the oxygen reservoir, the oxygen concentration can be increased to

70%.
The side ports are covered with one-way discs to prevent room air entering the
mask on inspiration and subsequently reducing the FiO 213.
The reservoir bag must remain inflated on inspiration and the oxygen flow rate
regulated so that it is sufficient enough to only deflate the bag by on
inspiration6,12.
When the child inspires, the air is drawn from the bag and through the holes in the
mask.
On expiration the first of air is blown back into the reservoir bag. This air comes
from the anatomic dead space and is still rich in oxygen, humidification and
contains very little carbon dioxide.
On the next inspiration the child inhales part of the previously exhaled air together
with 100% oxygen. This system results in less dilution by room air. 6

Page 32 of 42
6.4.1 PARTIAL RE-BREATHER PROCEDURE:

Follow steps 1 through 10 as per face mask procedure.
Additional Steps
Before placing bag and mask on child occlude the outlet from the reservoir bag
to the mask until the reservoir bag inflates.
6.5
Check all valves are functioning and that oxygen inlet valve moves freely.
NON RE-BREATHER BAG:
L/Min
Minimum of 8 - 15
FiO2
80 100%
The non rebreather bag and mask is simular to the partial re-breathing bag but it
has a one-way valve between the reservoir bag and the mask, and over the
exhalation ports of the mask.
These valves prevent the exhaled air from entering the bag and the inspiration of
room air through the port holes.
On inspiration, the port hole valves close and the reservoir valve opens allowing the
inspiration of 100% oxygen, if the mask fits snugly.
On exhalation the port valves open and the reservoir valve closes forcing the air out
into the atmosphere6,12.
This mask is used for children requiring high flow oxygen and requires a minimal
oxygen flow rate of 15 litre / min.
6.5.1 NON RE-BREATHER BAG PROCEDURE:

Additional Steps
Before placing bag and mask on child occlude the outlet from the reservoir
bag to the mask until the reservoir bag inflates.
Check all valves are functioning and that oxygen inlet valve moves freely.

Page 33 of 42
Recommended flow rate is minimum 8 to 15 litres (90-99% FiO2).
The valves between the mask and the reservoir should rise on inspiration and
lower on exhalation. Valves located on external mask surface should open
during exhalation.
6.6. VARIABLE CONCENTRATION MASK

(VENTURI OR AIR-ENTRAINMENT MASK)
L/Min
FiO2
12 15 L/min
Colour coded jets are attached to mask to deliver desired amount of

oxygen
Blue = 24%; Yellow = 28%; White = 31%; Green = 35%;
Pink = 40%; Orange = 50%
Colour and percentage of oxygen can change between different
manufacturers. Check product information on pack when usung.
Delivers a more accurate concentration of Oxygen than Hudson masks, and is able
to be calibrated with the device and easily monitored.
Requires a minimum flow rate of at least 5 litres / min and is dependent upon the
Oxygen concentration required.
Venturi mask (also called an air-entrainment mask) uses a nozzle to accelerate the
oxygen flow and mix it with air in a precise ratio. The venturi mask can deliver from
24% to 50% oxygen by using different adapters with different sized nozzle openings
varying the size of the opening where the room air enters the system (called
entrainment ports)5.

Page 34 of 42
6.6.1 VARIABLE CONCENTRATION MASK PROCEDURE:

Additional Steps
Adjust oxygen flow as per chart using correct colour attachment to deliver required
oxygen %.
6.7
BLOW OVER OXYGEN
This practice is designed for short periods only.
Can be used if child is requiring small amounts of oxygen to correct transient

respiratory compromise.
Can be used when the child is receiving nasal cannula oxygen and has increased
oxygen requirements with feeding or physical activity.
Owing to dilutional effects of ambient air, the effective FiO 2, which is the
hypopharyngeal, may be low and is unpredictable14.
Blow over oxygen is a transient measure and oxygen supplementation is to be

administered by other means if child remains unstable.
The Fio2 cannot be measured.
6.7.1 BLOW OVER OXYGEN PROCEDURE:
Connect oxygen tubing to 100% oxygen.
Adjust flow meter to deliver oxygen at 5 to 10 L/min.
Hold tube with or without mask attached above childs nose and mouth.
Deliver oxygen by:

-
Oxygen mask. Deliver oxygen close to the infant's face. Allow some oxygen to
escape around the mask.
If using oxygen tubing on its own cup hands around tubing and hold over the
infant's face.
Once the infant is pink, withdraw the oxygen gradually until the infant remains
pink on room air.
If the child remains compromised trial child on nasal prongs, mask, or bag and
mask depending clinical assessment

15
Page 35 of 42
6.8 TRANSPORT OXYGEN VIA PORTABLE CYLINDER
No need for humidification as only used for short periods
Cylinders may be laid on side
Flow meters must always be kept in upright position to read accurately
Check cylinder for fullness
Check cylinder for appropriate flow meter.
Attach oxygen tubing and delivery device
Adjust flow and place on child
7. WEANING
If the child is under the care of the specialist paediatric respiratory team the
weaning of oxygen is per order of the specialist.
To be commenced when childs clinical condition is improving as evidenced by

decreased work of breathing and normal respiratory rate, normal cardiovascular
parameters and O2 saturations >95% or as stated in the altered calling criteria.
Infants enrolled in the HFNP WHO Randomised Control Trial (July 16th 2012
August 31st 2014 or trial closeout) are to be weaned according to the trial standard
operating procedure (SOP) No.6 HFNP WHO RCT Procedure Manual.
8. EQUIPMENT CHECK
Care must be taken that all connections are secure and are tight, otherwise a
reduced volume or concentration will be administered.
Check the oxygen is flowing through the flow meter by turning the oxygen supply on
and placing finger at the outlet to feel flow.
Flow meters must be vertical to be read accurately.
Is the tubing twisted, kinked or blocked in some way? Check that all tubing is
connected securely and not kinked at any place.
Ensure the childs mouth or nose is not obstructed by food, secretions or other
articles.
Ensure the regulator/flow meters are on the correct setting as ordered by the
medical officer 6.

Page 36 of 42
9. DOCUMENTATION
Document the initiation of oxygen therapy, changes in therapy, and the effect
and tolerance of therapy.
All continuous and prn oxygen therapy must be documented at least once per
shift in the patients chart. The following is required documentation
Usage of therapy (continuous or prn)
Mode of delivery
Device
FIO2 and/or liter flow
SpO2
Indication 12
Oxygen therapy must be documented on the SPOC hourly.
All other observations and interventions are to be documented on the oxygen chart.
REFERENCES:
1. Warren G. Maguson Clinical Centre: National Institute of Health. Oxygen therapy
procedure. Bethesda, USA
2. Clinical Excellence Commission (2010). Between the flags, keeping patients safe:
Paediatric clinical emergency response system (CERS).
3. Aylott, M. (2006). Observing the sick child: Part 2a respiratory assessment.
Paediatric Nursing, 18, 9 ,38-44.
4. McCance, K., & Huether, S.E. Pathophysiology: The biological basis for disease in
adults and children. 4th Ed. Mosby, Missouri, USA.
5. Pruitt, W. and Jacobs, M. (2003). Breathing lessons: Basics of oxygen therapy.
Nursing 33, 10. 43-45.
6. The Childrens Hospital at Westmead. (2008) Oxygen therapy and delivery devices
procedure.

Page 37 of 42
7. Sim, M., Dean, P., Kinsella, J., Black, R., Carter, R., and Hughes, M. (2008)
Performance of Oxygen Delivery Devices when the breathing pattern of respiratory
failure is simulated. Anaesthesia, 63(9), 938 -940
8. Fell, H. and Boehm, M. (1998) Easing the discomfort of oxygen therapy, Nursing
Times, 94(38), 57-58.
9. Williams, R., Rankin, N., Smith, T., Galler D. and Seakins, P. (1996). Relationship
between the humidification and temperature of inspired gas and the function of the
airway mucosa. Critical Care Medicine 24(11)
10. Fisher & Paykel Healthcare Product Literature. RT329 Infant Oxygen Therapy
usage System. 2008
11. Fisher & Paykel Healthcare Product Literature. (2012). Optiflow Junior: Easy care,
effective flow.
12. Jevon, P. (2007). Respiratory Procedures Nursing Times, 103(32), 26 27
13. Mayo Health Care, Australia. Product information
http://www.mayohealthcare.com.au/products/Resp_oxygen_variableconcent_
mask.htm
14. Frey, B. and Shann, F. (2002). Oxygen administration in infants. Arch Dis Child
Fetal Neonatal Ed, 88. F84-F88
15. Princess Margaret Hospital for Children. (2010). Paediatric Nursing Practice
manual: 7.2.3 Humidified High Flow Nasal Cannula Therapy for Infants. Perth
DEPARTMENT OF HEALTH CIRCULARS:
NSW Health, (2006) Policy Directive: newborn Infants Safe oxygen administration
AREA POLICIES:
3.19
Recognition of the deteriorating paediatric patient
6.8
Fisher & Paykel Humidification System
6.4 Paediatric Oximetry
The Upper Hunter Emergency Guidelines: July 2004
John Hunter Neonatal Unit Oxygen Therapy Policy: May2003
The New Childrens Hospital, Westmead Oxygen Policy: 2000.
AUTHOR:
Bernadette Goddard Paediatric General Respiratory Clinical Nurse Consultant

Page 38 of 42
CONSULTATION:
Dr Bruce Whitehead Director of Tertiary services / Respiratory Staff specialist JHCH
Linda Cheese Paediatric Respiratory Clinical Nurse Consultant
Dr Larry Roddick Paediatric Staff Specialist
Dr Mark Lee Paediatric Emergency Staff Specialist
Elizabeth Kepreotes Clinical Improvement Coordinator
Leanne Lehle H1 NUM
Elizabeth Newham Paediatric Nurse Educator
APPROVED: CPGAG 16th July 2012
KGN Quality and Safety Committee 24th July 2012

Page 39 of 42
Appendix 1: Determining FiO2 Delivered from the Outlet Flow
OXYGEN DELIVERY DEVICE
OUTLET FLOW RATE

[LITRES / MIN ]
FiO2
Nasal Cannulae
1
2
24%
28%
Simple Mask
5
6
7
8
9
10
45%
50%
55%
60%
60-65%
6
8
10
12
15
35%
50%
60%
60-65%
65-70%
10
12
15
70-80%
80-85%
85-90%
Flow rate as indicated on

entrainment device
24%, 28%
30%, 35%
40%, 50%
10
15
up to 50%
over 50%
If available confirm with oxygen
analyser
Partial Rebreather
Non Rebreather
Venturi Mask
Disposable infant head box

Foldadome
FiO2 is influenced by patient inspiratory demand. FiO2 amounts are derived from the
manufacturers product information and are approximations for the adult population.
THESE FIGURES ARE A GUIDE AND WILL DIFFER FOR THE PAEDIATRIC POPULATION.
The exception is Venturi mask FiO2 figures which should remain constant regardless of
inspiratory demand.

Page 40 of 42
Appendix 2: Air and Oxygen Blends for WHO Fisher & Paykel Healthcare (2012)
O2 Flow
Air Flow
TOTAL
O2 Flow
Air Flow
TOTAL
L/min
L/min
Flow L/min
L/min
L/min
Flow L/min
21%
21%
30%
0.2
1.8
30%
40%
0.5
1.5
40%
50%
0.7
1.3
50%
60%
60%
3.5
3.5
21%
21%
30%
0.5
2.5
30%
40%
0.8
2.2
40%
50%
50%
60%
1.5
1.5
60%
21%
21%
30%
0.5
3.5
30%
40%
40%
50%
1.5
2.5
50%
3.5
5.5
60%
60%
4.5
4.5
21%
21%
10
30%
0.5
4.5
30%
40%
40%
2.5
7.5
50%
50%
3.5
6.5
60%
2.5
2.5
60%
21%
30%
0.5
5.5
40%
1.5
4.5
50%
2.5
3.5
60%
FiO2

FiO2
10
Page 41 of 42
Air and Oxygen Blends for WHO Fisher & Paykel Healthcare (2012)
O2 Flow
Air Flow
TOTAL
O2 Flow
Air Flow
TOTAL
L/min
L/min
Flow L/min
L/min
L/min
Flow L/min
21%
11
21%
16
30%
30%
14
40%
40%
12
50%
50%
10
60%
5.5
5.5
60%
21%
12
21%
17
30%
1.5
10.5
30%
15
40%
40%
13
50%
4.5
7.5
50%
11
60%
60%
8.5
8.5
21%
13
21%
18
30%
1.5
11.5
30%
16
40%
10
40%
4.5
13.5
50%
50%
12
60%
6.5
6.5
60%
21%
14
21%
19
30%
1.5
12.5
30%
17
40%
3.5
10.5
40%
4.5
14.5
50%
50%
12
60%
60%
9.5
9.5
21%
15
21%
20
30%
1.5
13.5
30%
18
40%
3.5
11.5
40%
15
50%
5.5
9.5
50%
7.5
12.5
60%
7.5
7.5
60%
10
10
FiO2

11
12
13
14
15
FiO2
16
17
18
19
20
Page 42 of 42

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6.

OXYGEN THERAPY AND DELIVERY DEVICES FOR

November 2011, August 2012

children, device, oximetry, oxygen, therapy, SaO2

SAFE WORK PRACTICE

Oxygen Guideline July 2012

SAFE WORK PRACTICE

1. Oxygen is highly combustible; therefore anything that supports or initiates

OXYGEN THERAPY PROCEDURE ......................................................................... 6

NURSING CARE FOR ALL CHILDREN ON OXYGEN THERAPY ........................... 10

DELIVERY SYSTEMS .............................................................................................. 11

Oxygen Guideline July 2012

TABLE 3: F & P OPTIFLOW JUNIOR NASAL CANNULA SIZE SELECTION TO

EQUIPMENT CHECK ............................................................................................... 37

DEPARTMENT OF HEALTH CIRCULARS ...................................................................... 38

Oxygen Guideline July 2012

Between the Flags

Fraction of inspired oxygen (%)

High-flow nasal prong to 8 L/min limit

Intensive Care Unit

John Hunter Childrens Hospital

Litres of gas flow per kilogram of body weight per

Litres of gas flow per minute

Neonatal Intensive Care Unit

Partial pressure of oxygen in arterial blood

Respiratory Distress Score

Standard Operating Procedure

Standard Paediatric Observation Chart

Warmed Humidified Oxygen

Oxygen Guideline July 2012

In order to increase the fraction of inspired oxygen concentration (FiO2) available to

Oxygen is to be ordered on the intervention section of an age appropriate Standard

Increased work of breathing, increased heart rate with progressive decrease in

In patients with chronic carbon dioxide retention whose stimulus to breathe is a

Oxygen Guideline July 2012

4. OXYGEN THERAPY PROCEDURE:

Observations must be recorded on an age appropriate NSW Health Standard

In the acute presentation, frequent observations should be attended and recorded.

Oxygen Guideline July 2012

4.1.1 SIGNS AND SYMPTOMS OF RESPIRATORY DISTRESS:

Restlessness initially progressing to

Increased Work of Breathing

Change in pattern of breathing including;

Use of accessory muscles and recession

Bradypnoea may indicate further

Mild hypoxia initially as pale colour due to

Later signs progressing to bluish grey

Oxygen Guideline July 2012

4.1.2 OBSERVATIONS TO ASSESS THE SIGNS AND SYMPTOMS OF

Respiratory effort and work of breathing as above.

SaO2 (in any amount of O2).

95% in room air is desirable unless an altered calling criterion is

90-95% indicates a need for increased observation and report to the

< 90% requires a rapid response as per SPOC zone protocol.

The response to the SaO2 reading is dependent:

On the childs normal baseline observation. Children with chronic

Oxygen Flow rate of gases and device.

Blood glucose level if necessary.

Oxygen Guideline July 2012

4.1.3 TABLE 1: NORMAL RANGES for ARTERIAL BLOOD GAS 4

Most important acid-base value; detects

Measures adequacy of ventilation and

Measures metabolic contribution to acid-base

Base excess (BE)