A nurse is performing a home safety assessment for a client who is receiving supplemental oxygen
Introduction Show Aim Definition of Terms Indications Contraindications Initiation Management: Acute Flow rate Humidification Complications Supplemental Oxygen Patient Monitoring Documentation Nursing Care Transfers Ceasing HFNP therapy Special Considerations Cleaning Companion Documents Links Evidence Table References IntroductionHumidified high flow nasal prong (HFNP) therapy is a form of non-invasive respiratory support. HFNP may act as a bridge between low flow oxygen therapies and CPAP, reducing the need for CPAP/intubation. At high flows of 2
litres per kilogram per minute, using appropriate nasal prongs, a positive distending pressure may be achieved. The high flows and humidification improve functional residual capacity and mucocililary clearance of secretions thereby reducing work of breathing. The high flows may also affect pulmonary and systemic circulation which is an important consideration when applying HFNP therapy to children with cardiac disease. AimThe aim of this guideline is to describe the indications and procedure for the use of High Flow Nasal Prong (HFNP) therapy within paediatrics. This guideline does not refer to the management of HFNP in the neonatal patient. Please refer to the Newborn Intensive Care Unit Definition of terms
IndicationsPatients requiring respiratory support.
Contraindications
Initiation
Management: Acute
Flow rateFlow rate for HFNP Therapy is the same for all patients regardless of medical condition
Humidification
Complications
Supplemental OxygenWhen HFNP therapy is commenced to provide respiratory support for children with non-respiratory issues, supplemental oxygen should be used cautiously with a FiO2 not greater than 0.3 In children with cyanotic congenital heart disease and balanced circulation, HFNP therapy is generally used with an FiO2 of 0.21 (air) or a low increased fraction of oxygen (≤30%) The addition of supplemental oxygen requires approval from Cardiac or PICU Consultant In children with clinical signs of upper airway obstruction (noisy breathing, tracheal tug, subcostal retractions, absence of tachypnoea) or potential obstruction e.g., post-op Ts & As on HFNP therapy should only receive FiO2 0.21 (air). The addition of supplemental oxygen requires approval from ENT or PICU Consultant. Supplemental Oxygen therapy should be commenced for patients on HFNP who display hypoxaemia
Where supplemental oxygen is required, titrate FiO2 to the minimum amount required to maintain target SpO2. Oxygen
therapy should be reduced or ceased if:
Patient monitoringObservation, patient clinical assessment and documentation should occur hourly at a minimum. Adjustment of frequency of patient observation and assessment should occur in response to clinical condition.
Documentation
Nursing care
Notes
TransfersThe Airvo requires main power and is not portable. Patients receiving HFNP therapy who require transfer must be escorted by a
nurse or doctor. Patients on HFNP with oxygen therapy, can be transferred on low flow oxygen therapy with HFNP re-established as soon as possible. If unstable off HFNP, patients require escalation of care prior to transport. Ceasing HFNP therapyWhen the child's clinical condition is improving as indicated by:
Wean FiO2 to 21% then cease HFNP therapy. HFNP therapy should not be routinely weaned, just stopped. Consider transfer to low flow nasal prong oxygen therapy where HFNP is no longer required but clinical requirement for oxygen persists. Consult section on weaning oxygen on the Oxygen Nursing
Clinical Guideline. Continue pulse oximetry monitoring for 30 minutes post cessation of HFNP therapy, perform vital sign observation, intermittent SpO2 monitoring 30 minutes later, then hourly for 2 hours. Where cessation of HFNP therapy is successful – usually known within 2 hours of stopping - continuous pulse oximetry monitoring may be discontinued. Unless contraindicated, an attempt to wean oxygen or cease HFNP flow should be made at least once per
shift. Special ConsiderationsCleaning
Companion documents
Links
Evidence tableClick here to view the evidence table. The development of this clinical guideline was coordinated by John Kemp, Clinical Support Nurse and Respiratory CNC, Sugar Glider and the coordination of making this guideline hospital wide was done by Sophie Linton, CNC, Nursing Innovation; and approved by the Nursing Clinical Effectiveness Committee. Updated November 2021. |