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Clinical Guidelines (Nursing)

RCH > Other > Oxygen delivery
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Oxygen delivery

Introduction
Definition of terms
Normal values
Indications for oxygen delivery
Nurse initiated oxygen

Patient assessment and documentation

Selecting the delivery method
Low flow delivery method
High flow delivery method
Air entrainment devices
Humidification
o
o

Fisher & Paykel MR850 Humidifier

AIRVO 2 Humidifier

Delivery mode
o
o

o
o

Quick reference table for mode of delivery

Nasal Prongs
Nasal prongs without humidification
Nasal prongs with humidification (see appendix A for sizing guide)
Optiflow Nasal prongs humidification using MR850 Humidifier
Optiflow Nasal prongs humidification using AIRVO 2 humidifier
Face mask
Simple face mask
Nebuliser mask
Non-rebreathing face mask
Tracheostomy
Isolette

Considerations
o
o

Potential complications of oxygen use

Oxygen Safety

Links to related guidelines

Appendix A - Paediatric sizing guides for nasal prongs
Evidence Table (coming soon)
References

Introduction
The goal of oxygen delivery is to maintain targeted SpO2 levels in children through the
provision of supplemental oxygen in a safe and effective way which is tolerated by
infants and children to:
o
o
o
o
o

Relieve hypoxaemia and maintain adequate oxygenation of tissues and vital

organs, as assessed by SpO2 /SaO2 monitoring and clinical signs.
Give oxygen therapy in a way which prevents excessive CO2 accumulation - i.e.
selection of the appropriate flow rate and delivery device.
Reduce the work of breathing.
Maintain efficient and economical use of oxygen.
Ensure adequate clearance of secretions and limit the adverse events of
hypothermia and insensible water loss by use of optimal humidification
(dependant on mode of oxygen delivery.)

Definition of terms
o
o
o
o
o
o

o
o

o
o
o
o
o

FiO2: Fraction of inspired oxygen (%).

PaCO2: The partial pressure of CO2 in the blood. It is used to assess the adequacy
of ventilation.
PaO2: The partial pressure of oxygen in the blood. It is used to assess the
adequacy of oxygenation.
SaO2: Arterial oxygen saturation measured from blood specimen.
SpO2: Arterial oxygen saturation measured via pulse oximetry.
Air entrainment device (venturi principle): Allows air to be incorporated in to
the oxygen/ humidification circuit, resulting in an accurate percentage of oxygen
being delivered to the patient. This results in an increased flow volume to the
patient, up to 45 LPM. Where the total flow delivered to the patient meets or
exceeds their Peak Inspiratory Flow Rate the FiO2 delivered to the patient will be
accurate.
Heat Moisture Exchange (HME) product: are devices that retain heat and
moisture minimizing moisture loss to the patient airway.
High flow: High flow systems are specific devices that deliver the patient's entire
ventilatory demand (minute volume.) High flow in approved areas only. Consult
your NUM if unsure.
Humidification is the addition of heat and moisture to a gas. The amount of
water vapor that a gas can carry increases with temperature.
Hypercapnea: Increased amounts of carbon dioxide in the blood.
Hypoxaemia: Low arterial oxygen tension (in the blood.)
Hypoxia: Low oxygen level at the tissues.
Low flow: Low flow systems are specific devices that do not provide the patient's
entire ventilatory requirements.

o
o
o

Minute ventilation: The total amount of gas moving into and out of the lungs per
minute. The minute ventilation (volume) is calculated by multiplying the tidal
volume by the respiration rate, measured in litres per minute.
Peak Inspiratory Flow Rate (PIFR): The fastest flow rate of air during
inspiration, measured in litres per second.
Tidal Volume: The amount of gas that moves in, and out, of the lungs with each
breath, measured in millilitres (6-10 ml/kg).
Ventilation - Perfusion (VQ) mismatch: An imbalance between alveolar
ventilation and pulmonary capillary blood flow.

Normal Values
o

o
o
o

Partial pressure of arterial oxygen (PaO2)

80 -100 mmHg - children/adults
50 - 80 mmHg - neonates
Partial pressure of arterial CO2 (PaCO2)
35 - 45 mmHg children/adults
pH = 7.35 -7.45
SpO2
>95% for infants, children and adults
>91% for neonates (Click here for Premature Neonates SpO2 guideline)
>60% Cyanotic heart disease

NB: The above values are genearlised to the paediatric population, for age specific
ranges please consult CLARA and/or the medical team.

The above values are expected target ranges. Any deviation should be documented on the
observation chart as MET modifications.

Indications for oxygen delivery

o
o
o

The treatment of documented hypoxia/hypoxaemia as determined by SpO2 or

inadequate blood oxygen tensions (PaO2).
Achieving targeted percentage of oxygen saturation (as per normal values unless a
different target range is specified on the observation chart.)
The treatment of an acute or emergency situation where hypoxaemia or hypoxia is
suspected, and if the child is in respiratory distress manifested by:
dyspnoea, tachypnoea, bradypnoea, apnoea
pallor, cyanosis
lethargy or restlessness

use of accessory muscles: nasal flaring, intercostal or sternal recession,

tracheal tug

If you require further information please click here for the Assessment of Severe
Respiratory Conditions guideline.
o
o

Short term therapy e.g. post anaesthetic or surgical procedure

Palliative care - for comfort

Oxygen is a drug and requires a medical order. Each episode of oxygen delivery
should be ordered on the medication chart either as a one-off order or on-going
treatment.

Nurse initiated oxygen

o
o
o

Nurses can initiate oxygen if patients breach expected normal parameters of

oxygen saturation
A medical review is required within 30 minutes
At the time of the medical review a prescription for oxygen should be written

Patient assessment and documentation

o

o
o

o
o

Clinical assessment and documentation including but not limited to:

cardiovascular, respiratory and neurological systems should be done at the
commencement of each shift and with any change in patient condition.
Check and document oxygen equipment set up at the commencement of each shift
and with any change in patient condition.
Hourly checks should be made for the following:
oxygen flow rate
patency of tubing
humidifier settings (if being used)
Hourly checks should be made and recorded on the patient observation chart for
the following (unless otherwise directed by the treating medical team):
heart rate
respiratory rate
work of breathing (descriptive assessment - i.e. use of accessory
muscles/nasal flaring)
oxygen saturation
Ensure the individual MET criteria are observed regardless of oxygen
requirements
Clinical Guidelines (Nursing): Nursing Assessment

Selecting the delivery method

A range of flow meters are available at RCH (0-1 LPM, 0-2.5 LPM, 0-15 LPM, 0-50
LPM (PICU only). Check on the individual flow meter for where to read the ball (i.e.
centre or top of ball), or dial (Perflow brand of flow meters) when setting the flow rate.

Note: Some flow meters may deliver greater than the maximum flow indicated on the
flow meter if the ball is set above the highest amount. Use caution when adjusting the
flow meter.

Oxygen delivery method selected depends on:

o
o
o
o

age of the patient

oxygen requirements/therapeutic goals
patient tolerance to selected interface
humidification needs

Note: Oxygen therapy should not be delayed in the treatment of life threatening hypoxia.

Low flow delivery method

Low-flow systems include:
o
o
o
o
o
o

Simple face mask (without air entrainment device)

Non re-breather face mask (mask with oxygen reservoir bag and one-way valves
which aims to prevent/reduce room air entrainment)
Nasal prongs (low flow)
Tracheostomy mask (without air entrainment device)
Tracheostomy HME connector
Isolette - neonates (usually for use in the Neonatal Unit only)

Note: In low flow systems the flow is usually titrated (on the flow meter) and recorded in
litres per minute (LPM).

High flow delivery method

High flow systems include:

o
o
o
o

Ventilators
CPAP/BiPaP drivers
Face mask or tracheostomy mask used in conjunction with an entrainment device
or AIRVO 2 Humidifier
High flow nasal prongs (HFNP)

Air entrainment devices

When using an air entrainment device it is important that:
o
o

Oxygen must be humidified and warmed (MR850 Humidifier set on Non-Invasive

Mode) as compressed gas is drying and may damage the tracheal mucosa.
To achieve the desired FiO2 use the diagram below. This table advises the
appropriate air entrainment position for desired FiO2 the oxygen flow rate and
total flow that will be delivered to patient when these settings are utilized. To
ensure the patient is breathing the FiO2 that the device is delivering the total flow
should equal or exceed the patients Peak Inspiratory Flow Rate. This is not really
measureable but is at least 3 to 4 times the patients minute ventilation.
Note: Air entrainment devices are not effective for delivering FiO2 greater than
50%

Documentation:
o

Document the FiO2 as indicated on air entrainment device & total flow as per Air
Entrainer chart below and wall O2 flowmeter flow.

Air Entrainer: %O2 to recommended oxygen flow guide

Humidification
Oxygen therapy can be delivered using a low flow or high flow system. All high flow
systems require humidification. The type of humidification device selected will depend
on the oxygen delivery system in use, and the patient's requirements. The humidifier
should always be placed at a level below the patient's head.
Rationale:
o
o
o
o

Cold, dry air increases heat and fluid loss

Medical gases including air and oxygen have a drying effect and mucous
membranes become dry resulting in airway damage.
Secretions can become thick & difficult to clear or cause airway obstruction
In some conditions e.g. asthma, the hyperventilation of dry gases can compound
bronchoconstriction.

Indications:
o
o
o
o
o

Patients with thick copious secretions

Non-invasive and invasive ventilation
Nasal prong flow rates of greater than 2 LPM (under 2 years of age) or 4 LPM
(over 2 years of age)
Facial mask flow rates of greater than 5 LPM
Patients with tracheostomy

RCH predominantly uses the Fisher & Paykel MR850 Humidifier & AIRVO 2
Humidifier. Please consult user manuals for any other models in use.

Fisher & Paykel MR 850 Humidifier

Follow instructions in the MR850 User Manual in conjunction with this Guideline
Has two modes:
o

Invasive Mode - delivers saturated gas as close to body temperature (37 degrees,
44mg/L) as possible.
Suitable for patients with bypassed airways:
Invasive Ventilation
Tracheostomy attachment or mask
Nasal Prongs
Non-Invasive Mode delivers gas at a comfortable level of humidity (31-36
degrees, >10mg/L).
Suitable for patients receiving:
Face mask therapy:
Non-invasive ventilation (CPAP/BIPAP)
Nebuliser mask (with RT308 circuit)

AIRVO 2 Humidifier
Follow instructions in the AIRVO 2 User Manual in conjunction with this Guideline.
Has two modes:
o

Junior Mode
Suitable for patients using Optiflow Junior Infant and Paediatric Nasal
Prongs
Standard Mode
Suitable for patients using:
Optiflow adult nasal prongs
Nebuliser mask (via Mask Interface Adaptor)
Tracheostomy mask (via Mask Interface Adaptor)
Tracheostomy direct connection

Link to: Optiflow Nasal Prong Flow Rate Guide

WARNING: Do not cover Airvo breathing circuit with linen, or use on a patient in an
isolette or overhead heater cot (see User Manual)
The AIRVO 2 Humidifier requires cleaning and disinfection between patients.
Follow the instructions in the disinfection kit manual:

For routine cleaning instructions please refer to the following link: RCH Equipment
Cleaning Table Prepared by Infection Prevention and Control Team
When commencing therapy on a new patient, ensure the disinfection cycle was
performed. On device start up, a green traffic light confirms the AIRVO 2 is safe for use
on a new patient. An orange traffic light confirms the AIRVO 2 has not been cleaned and
disinfected since last use, and is not safe for use on a new patient.

Delivery Mode
Click to view the delivery mode quick reference table

Simple Nasal Prongs

Nasal prongs without humidification
This system is simple and convenient to use. It allows the oxygen therapy to continue
during feeding/eating and the re-breathing of CO2 isn't a potential complication.
Simple nasal prongs are available in different sizes To ensure the patient is able to entrain

room air around the nasal prongs and a complete seal is not created the prong size should
be approximately half the diameter of the nares. Select the appropriate size nasal prong
for the patient's age and size.

Note: Do not use air entrainment device with simple nasal prongs.

A maximum flow of:

o
o

2 LPM in infants/children under 2 years of age

4 LPM for children over 2 years of age.

With the above flow rates humidification is not usually required. However, if
humidification is clinically indicated - set up as per the recommended guidelines for the
specific equipment used. As with the other delivery systems the inspired FiO2 depends on
the flow rate of oxygen and varies according to the patient's minute ventilation.
Care and considerations of child with simple nasal prongs:
o
o

o
o
o

Position the nasal prongs along the patient's cheek and secure the nasal prongs on
the patient's face with adhesive tape.
Position the tubing over the ears and secure behind the patient's head. Ensure
straps and tubing are away from the patient's neck to prevent risk of airway
obstruction.
Check nasal prong and tubing for patency, kinks or twists at any point in the
tubing and clear or change prongs if necessary.
Check nares for patency - clear with suction as required.
Change the adhesive tape weekly or more frequently as required

Nasal prongs with humidification system

If the flow rate exceeds those as recommended above this may result in nasal discomfort
and irritation of the mucous membranes. Therefore, humidification of nasal prong oxygen
therapy is recommended.
Note: Do not use air entrainment device with simple nasal prongs
Humidification can be provided using either the MR850 Humidifier or the AIRVO 2
Humidifier. Follow the manufacturer's Instructions for Use for each device and setup.

Optiflow Nasal Prongs Humidification using MR850 Humidifier

Optiflow nasal prongs are compatible for use in humidified low or high flow oxygen
delivery.

Note: MR850 Humidifier should be placed in Invasive Mode for Nasal Prongs Therapy.
See guides below for recommended patient sizing and flow rates.

Fisher and Paykel Optiflow nasal cannula junior range

Four sizes of prongs:
o
o
o
o

Premature
Neonate
Infant
Paediatric

See Appendix A for further information regarding appropriate junior range sizing: Fisher
and Paykel Optiflow junior range sizing guide
Fisher and Paykel Optiflow nasal cannula standard range
Three sizes of prongs
o

Small

o
o

Medium
Large

Paediatric Patients
(RT330 circuit - click here for instructions for use)
o
o
o
o

High flow (in approved areas only, see relevant guidelines)

Flow of 2 L/kg/min up to 10kg, plus 0.5 L/kg/min for each kg above 10kg (to a
maximum of 50 LPM)
FiO2 21-50% (blender must be used)
FiO2 above 50% requires PICU review

The main safety feature of the RT330 Oxygen Therapy System is the pressure relief
valve. The pressure relief valve has been set to a limit of < 40 cm H20. This valve has
been designed to minimize the risk of excessive pressure being delivered to the infant in
the event that the nasal prongs seal around the infant's nares while the mouth is closed.

The image below is of the RT330 circuit.

Below is an image of the RT330 pressure relief valve.

Older children and adolescent patients

(RT203 Circuit and O2 stem - click here for instructions for use)
o

3 sizes of prongs:
Small
Medium
Large
Low flow, a maximum of:
4 LPM for children over 2 years of age
FiO2 21-100% (direct from O2 wall source or via a blender)
High flow (in approved areas only, see relevant recommendations above)
Flow of 2L/kg/min up to 10kg, plus 0.5L/kg/min for each kg above 10kg
(to a maximum of 50LPM)
FiO2 above 50% requires PICU review

Optiflow Nasal Prongs Humidification using AIRVO 2 Humidifier

The AIRVO 2 Humidifier has two modes:
o
o

Junior Mode
Standard Mode

Junior Mode
o

Suitable for patients using the Optiflow Junior Nasal Prongs

Two sizes of Optiflow Junior nasal prongs suitable for use with AIRVO 2
Humidifier
Optiflow Junior Infant
Optiflow Junior Paediatric
FiO2 21-95%
High Flow (in approved areas only, see relevant guideline)
Flow of 2L/kg/min up to 10kg, plus 0.5L/kg/min for each kg above 10kg
(to a maximum of 50 LPM)
FiO2 21-50%

Patients requiring FiO2 > 50% require a medical review and close
monitoring. Consider PICU transfer if after one hour no clinical
improvement has occurred
Fisher and Paykel Optiflow nasal cannula junior range for AIRVO 2

Below is an image of the Fisher and Paykel Optiflow nasal cannula junior range for
AIRVO 2

Standard Mode
o

Three sizes of Optiflow nasal prongs suitable for use with AIRVO 2 Humidifer
(click here for: Fisher and Paykel Optiflow (adult) nasal cannula standard range
guide)
Small
Medium
Large
High Flow (in approved areas only)
Flow of 2L/kg/min up to 10kg, plus 0.5L/kg/min for each kg above 10kg
(to a maximum of 50 LPM)
FiO2 21-50%
Patients requiring FiO2 > 50% require a medical review and close
monitoring. Consider PICU transfer if after one hour no clinical
improvement has occurred

Optiflow Nasal Prong junior and standard humidification and flow rate guide for Airvo.

Face Mask
Click to view the delivery mode quick reference table

Simple Face Mask

The FiO2 inspired will vary depending on the patient's inspiratory flow, mask fit/size and
patient's respiratory rate. At RCH both simple face masks (in various sizes) and
tracheostomy masks are available.

The minimum flow rate through any face mask or tracheostomy mask is 4 LPM as
this prevents the possibility of CO2 accumulation, CO2 re-breathing and drowsiness.
Select a mask which best fits from the child's bridge of nose to the cleft of jaw, and adjust
the nose clip and head strap to secure in place.
Oxygen (via intact upper airway) via a simple face mask at flow rates of 4LPM does not
require routine humidification. However, as compressed gas is drying and may damage
the tracheal mucosa humidification might be indicated/appropriate for patients with

secretions retention, or discomfort. Additionally in some conditions (eg. Asthma), the

inhalation of dry gases can compound bronchoconstriction.

Nebuliser mask
Nebuliser mask or tracheostomy mask in conjunction with a humidification system
A nebuliser mask or tracheostomy mask with an air entrainment device is intended for
use with a MR850 Humidifier). By entraining room air into the delivery system, the total
gas flow to the patient can be increased up to approximately 45 LPM. When the
instructions on the air entrainment device are followed, it is possible to deliver a specific
FiO2. This system is useful in accurately delivering low concentrations of oxygen (2850%).
A nebuliser mask or tracheostomy mask with a mask interface adaptor is intended for use
with an AIRVO 2 Humidifier. A tracheostomy direct connection may be used with an
AIRVO 2 Humidifier. The AIRVO 2 Humidifier flow rate should be set to meet or
exceed the patient's entire ventilatory demand, to ensure the desired FiO2 is actually
inspired by the patient. This system is useful in accurately delivering concentrations of
oxygen (21 95%). Patients who require an FiO2 greater than 50% require medical
review.
With both systems, as the gas flow is > 4LPM re-breathing of expired gas is not a
potential problem. Therefore this system reduces the risk of carbon dioxide retention.
NOTE: While a specific FiO2 is delivered to the patient the FiO2 that is actually inspired
by the patient (ie what the patient actually receives) varies depending on:
o
o
o

flow rate delivered to the patient (see air entrainment device below)
mask size and fit
the patient's respiratory rate

Non-rebreathing face mask

A non-rebreathing face mask is a mask with an oxygen reservoir bag that has a one-way
valve system which prevents exhaled gases mixing with fresh gas flow. The nonrebreathing mask system may also have a valve on the side ports of the mask which
prevents entrainment of room air into the mask. These masks are not commonly used but
a non-rebreathing mask can provide higher concentration of FiO2 (> 60%) than is able to
be provided with a standard face mask (which is approximately 40% - 50%)

Considerations when using a non-rebreathing face mask

o

To ensure the highest concentration of oxygen is delivered to the patient the

reservoir bag needs to be inflated prior to placing on the patients face.

o
o

Ensure the flow rate from the wall to the mask is adequate to maintain a fully
inflated reservoir bag during the whole respiratory cycle (i.e. inspiration and
expiration).
Do not use with humidification system as this can cause excessive 'rain out' in the
reservoir bag.
Not routinely used outside of ED and PICU and should only be used in
consultation with the medical team.

Tracheostomy
Click to view the delivery mode quick reference table
Tracheostomy HME - Heat Moisture Exchanger (Swedish nose filter) with oxygen
attachment

In spontaneously breathing tracheostomy patients who require oxygen flow rates of less
than 4 LPM there are two options available:
o
o

OXY-VENT with Tubing: The adaptor sits over the TRACH-VENT and the
tubing attaches to the oxygen source (flow meter).
TRACH-VENT+: Alternatively a Hudson RCI HME - TRACH-VENT+
(Swedish nose filter) has an integrated oxygen side port which connects directly
to oxygen tubing which is attached to the oxygen source (flow meter).
Note: HME are used without a heated humidifier circuit.

Considerations:
o
o

The Hudson Trach-Vent HME has a dead space of 10mL and is recommended
for use in patients who have tidal volumes of 50mL and above.
Trach-Vent's are changed daily or as required if contaminated or blocked by
secretions.

Isolette
At the RCH, oxygen therapy via an isolette is usually only for use in the Butterfly
neonatal intensive care unit. (See Isolette use in paediatric wards, RCH internal link
only.)

Considerations
o

Oxygen is a drug and use outside of an emergency situation should be prescribed

by a medical practitioner

o
o
o

Supplemental oxygen relieves hypoxaemia but does not improve ventilation or

treat the underlying cause of the hypoxaemia. Monitoring of SpO2 indicates
oxygenation not ventilation. Therefore, beware the use of high FiO2 in the
presence of reduced minute ventilation.
Many children in the recovery phase of acute respiratory illnesses are
characterised by ventilation/perfusion mismatch (e.g. asthma, bronchiolitis, and
pneumonia) and can be managed with SpO2 in the low 90's as long as they are
clinically improving, feeding well and don't have obvious respiratory distress.
Normal SpO2 values may be found despite rising blood carbon dioxide levels
(hypercapnea). High oxygen concentrations have the potential to mask signs and
symptoms of hypercapnea.
Oxygen therapy should be closely monitored & assessed at regular intervals
Therapeutic procedures & handling may increase the child's oxygen consumption
& lead to worsening hypoxaemia
Children with cyanotic congenital heart disease normally have SpO2 between
60%- 90% in room air. Increasing SpO2 > 90% with supplemental oxygen is not
recommended due to risk of over circulation to the pulmonary system while
adversely decreasing systemic circulation. However, in emergency situations with
increasing cyanosis supplemental oxygen should be administered to maintain their
normal level of SpO2

Potential complications of oxygen use

o

o
o
o

CO2 Narcosis - This occurs in patients who have chronic respiratory obstruction
or respiratory insufficiency which results in them developing hypercapnea (i.e.
raised PaCO2). In these patients the respiratory centre relies on hypoxaemia to
maintain adequate ventilation. If these patients are given oxygen this can reduce
their respiratory drive, causing respiratory depression and a further rise in PaCO2
resulting in increased CO2 levels in the blood and CO2 narcosis.
Monitoring of SpO2 or SaO2 informs of oxygenation only. Therefore, beware of
the use of high FiO2 in the presence of reduced minute ventilation.
Pulmonary Atelectasis
Pulmonary oxygen toxicity - High concentrations of oxygen (>60%) may
damage the alveolar membrane when inhaled for more than 48 hours resulting in
pathological lung changes.
Retrolental fibroplasia (also known as retinopathy of prematurity) An alteration
of the normal retinal vascular development, mainly affecting premature neonates
(<32 weeks gestation or 1250g birthweight), which can lead to visual impairment
and blindness.
Substernal pain-due: characterised by difficulty in breathing and pain within
the chest, occurring when breathing elevated pressures of oxygen for
extended periods.

Oxygen safety

Oxygen is not a flammable gas but it does support combustion (rapid burning). Due to
this the following rules should be followed:
o
o
o

o
o
o
o

Do not smoke in the vicinity of oxygen equipment.

Do not use aerosol sprays in the same room as the oxygen equipment.
Turn off oxygen immediately when not in use. Oxygen is heavier than air and
will pool in fabric making the material more flammable. Therefore, never leave
the nasal prongs or mask under or on bed coverings or cushions whilst the oxygen
is being supplied.
Oxygen cylinders should be secured safely to avoid injury.
Do not store oxygen cylinders in hot places.
Keep the oxygen equipment out of reach of children.
Do not use any petroleum products or petroleum byproducts e.g. petroleum
jelly/Vaseline whilst using oxygen.

Link to related guidelines

o
o
o
o
o
o
o
o
o
o
o
o
o
o

PICU High Flow Nasal Prong HFNP oxygen guideline

Isolette (RCH internal link)
Oxygen Saturation Sp02 Level Targeting - Premature neonates
AIRVO 2 Humidifier user manual
AIRVO2 Disinfection kit manual
RT203 Instructions for use
Optiflow RT330 Instructions for use
Optiflow Adult Nasal Cannula instructions for use
Optiflow Junior Nasal Cannula instructions for use
RCH CPG Assessment of Severity of Respiratory Issues
User manual for MR850
F&P Optiflow Junior Nasal Cannula Fitting Guide
F&P Optiflow Junior Consult Instructions For Use
Clinical Guidelines (Nursing): Nursing Assessment

Appendix A - Pediatric sizing guides for nasal prongs

Fisher and Paykel Optiflow junior range sizing guide

Evidence Table
... coming soon

References
Bateman, N.T. & Leach, R.M. (1998). ABC of Oxygen - Acute oxygen therapy. BMJ,
September 19; 317(7161): 798-801.

Dunn, L., & Chisholm, H. (1998). Oxygen Therapy. Nursing Standard, 13(7), 57 - 60.

Fell, H., & Boehm, M. (1998). Easing the discomfit of oxygen therapy. Nursing Times,
94 (38), 56 - 58.

Frey, B., & Shann, F. (2003). Oxygen administration in infants. Archives of Disease in
Childhood - Fetal and Neonatal Edition, 88, F84 - F88.

Oh, T.E. (1990). Intensive Care Manual 3rd Edition. Sydney: Butterworths.

Shann, F., Gatachalian, S., & Hutchinson, R. (1988). Nasopharyngeal oxygen in children.
The Lancet. 1238 -1240.

St. Clair, N., Touch, S. M., & Greenspan, S. (2001) Supplemental Oxygen Delivery to the
Nonventilated Neonate. Neonatal Network. 20 (6), 39-45.

Bersten, A. & Soni, N. (Eds). (2009). Oh's Intensive Care Manual 6th Edition. China:
Butterworth Heinemann Elsevier

Schibler, A., Pham, T.,Dunster, K., Foster, K., Barlow, A., Gibbons, K., and Hough, J.
(2011) Reduced intubation rates for infants after introduction of high-flow nasal prong
oxygen delivery. Intensive Care Medicine. May;37(5):847-52

McKieman, C., Chua, L.C., Visintainer, P. and Allen, P. (2010) High Flow Nasal
Cannulae Therapy in Infants with Bronchiolitis. Journal of Pediatrics 156:634-38

Spentzas, T., Minarik, M., Patters, AB., Vinson, B. and Stidham, G. (2009) Children with
respiratory distress treated with high-flow nasal cannula. Journal of Intensive Care
Medicine. 24(5): 323-8

Miyamoto, K. & Nishimura, M. "Nasal Dryness Discomfit in Individuals Receiving Dry

Oxygen via Nasal cannula" Respiratory Care April (2008) Vol 35 No. 4 503 504

Ricard, J. & Boyer, A. "Humidification during oxygen therapy and non-invasive

ventilation: do we need some and how much"? Intensive Care Med (2009) 35: 963-965

Campbell, E.; Baker, D. & Crites-Silver, P. " Subjective Effects of Humidification of

oxygen for delivery by nasal cannula" Chest (1988) Vol 93: 2 289 - 293
Please remember to read the disclaimer.

Revision of the Oxygen delivery guideline, origionally published Oct 2012, was
coordinated by Sueellan Jones, Respiratory Nurse Consultant, Department of Respiratory
Medicine, and Brenda Savill, Nurse Educator, Nursing Education. Approved by the
Clinical Effectiveness Committee. Authorised by Bernadette Twomey, Executive
Director Nursing Services. Revised guidelines published November 2013.

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