Cmplex Care Hub Manual: High Flw Nasal Prng (HFNP) Oxygen Therapy Table f Cntents 1. What is High Flw Therapy?... 2 2. Humidificatin... 2 2.1 What is humidificatin?... 2 2.2 Mechanical humidificatin... 2 3. The Airv2 circuit... 2 3.1 Setting up the AIRVO 2 and circuit... 2 3.2 Using the AIRVO2... 3 4. Trubleshting airway pressure mnitr alarms... 4 5. Standard checks f a child n AirVO 2... 5 6. Start f shift equipment checks... 5 6.1 AIRVO 2 and circuit... 5 6.2 Oxygen Saturatins mnitr (t be used if child is n xygen) refer t xygen saturatins manual... 5 7. Hurly checks... 6 8. Safety when using a humidifier... 6 This manual is written using infrmatin frm the Fisher & Paykel AIRVO2 manual. It is nt intended t replace the fficial manual which shuld be available at all times t the family and supprt wrker. Versin 3.0 Date revised January 2015 Next revisin date January 2017 Page 1 f 6
1. What is High Flw Therapy? High flw xygen via nasal prngs is a way f giving the child humidified (warmed and mistened) air, and/r xygen and psitive airway pressure (PAP) Giving high flw xygen t a child means they d nt have t wrk s hard t take each breath and it als helps them t get a gd amunt f air int their lungs. If we did nt give them high flw xygen the child wuld have t wrk much harder t breath and their airways wuld becme damaged frm the dry air. A child wh has t wrk hard t breathe gets tired quickly and will becme very unwell and may stp breathing (be apneic) if they d nt receive help immediately. High flw air that is warmed and mistened (humidified) is delivered t the child using a humidifier called the AIRVO 2. The humidified air and flw is mst cmmnly delivered t the child using nasal prngs (HFNP) but can als be used with a face mask r cnnected t a trachestmy. N.B. Face Mask and Trache cnnectr prvide flw but nt pressure. 2. Humidificatin 2.1 What is humidificatin? Humidificatin is the warming and mistening f the air we breathe. When we breathe nrmally the air is humidified by the nse and muth. When we give air r pressure t a child using a machine we bypass r decrease the bdy s ability t humidify the air naturally. We need t use a mechanical humidifier t add misture and warmth t the air given t them in rder t prevent damage t the child s airways by keeping the mucus membranes mist and stpping the child s secretins frm becming t thick and dry. 2.2 Mechanical humidificatin The mechanical humidifier is a machine that adds misture and warmth int a circuit that is used t give air t the child. The humidifier is used t deliver air at a set temperature. It is nt affected by changes in rm temperature r flw rate thrugh the humidifier. A child receiving high flw xygen may be able t d withut heated humidificatin fr a shrt perid but may require xygen via anther frm if unable t use the humidifier. 3. The Airv2 circuit The circuit includes: The Airv2 base unit The humidifier chamber The heated breathing tube The nasal cannula (varius sizes) Wiggle pads Oxygen This is nt part f the prvided AIRVO2 circuit and if required will be delivered t the AIRVO2 via a cncentratr r xygen cylinder see xygen manual. 3.1 Setting up the AIRVO 2 and circuit 1. The AIRVO2 base unit shuld be fixed t a ple r in a psitin belw the child s head. Page 2 f 6
2. Remve the blue prt caps frm the water chamber and adapter. 3. Fit the adapter ver the tw vertical prts and push n fully then clip the water supply int psitin. 4. Fit the chamber t the unit by pressing dwn the finger guard and sliding the chamber n, carefully aligning with the blue chamber prt ends. Push the chamber n firmly until the finger guard clicks int place. 5. Cnnect the water bag t the hanging bracket 20cm abve the unit, and push the bag spike int the fitting at the bttm f bag. Open the vent cap n the side f the bag spike. The chamber will nw autmatically fill t the required level and maintain that level until the water bag is empty (this may nt apply t circuits in the hme cnfirm with the nurse). 6. T ensure cntinual humidificatin, always ensure that the water bag and chamber are nt allwed t run ut f water. 7. Check that water flws int and is maintained belw the fill line. If the water rises abve the fill line, replace the chamber. 8. One end f the heated breathing tube has a blue plastic sleeve. Lift the sleeve and slide the cnnectr nt the unit. Push the sleeve dwn t lck. 9. Cnnect nasal cannula t adaptr n circuit tubing, and cnnect circuit tubing t humidifier 10. If xygen is t be used, attach air and xygen hses frm xygen supply and cnnect t humidifier 3.2 Using the AIRVO2 Switch n unit it must be plugged int mains pwer as there is n battery backup Check disinfectin status; in the hme yu will either see an range r green light, bth clurs are acceptable. Warm up the unit is warming up d nt tuch. Once unit has warmed up yu will see a circle with a tick in the middle. Cnfirm the AIRVO2 is in the crrect mde in junir mde yu will see a butterfly and a bird flying n the screen. Oxygen cnfirm xygen setting matches prescribed rders in the child specific care page Yu can adjust the xygen (within the set limits n the care page) s that Fi02 % level displayed matches the prescribed Fi2. If the Fi02 displayed des nt match the prescribed amunt and yu are giving the maximum xygen prescribed then yu need t infrm the family. Yu will als need t assess the child fr any signs f breathing difficulty. Cnnect Patient t circuit Press start Page 3 f 6
4. Trubleshting airway pressure mnitr alarms The AIRVO2 has alarms that are set t alert yu that there is a prblem. When an alarm ges ff yu must always check the child befre yu take any further actin, including silencing the alarm. Alarm What caused it Hw t fix the prblem Fault Check tube The unit has detected an internal fault and has shut dwn. The unit cannt detect the heated breathing tube. Switch unit ff and then restart. If it persists call parent. Check tube is nt damaged r kinked. And is plugged in crrectly. If it persists change the heated breathing tube. Check fr leaks. Check fr blckages Yu will hear an intermittent alarm tne and see the alarm light Oxygen t lw (if xygen in use) Oxygen t high (if xygen in use ) Cannt reach target Check water Pwer Out Leak in the system Blckage in the system Oxygen level fallen belw allwed limit. Oxygen level in excess f allwed limit. The unit cannt reach the target flw setting The chamber has run ut f water Unit discnnected frm mains pwer Check child and circuit Check circuit fr leaks and change circuit if necessary Check circuit. Check air filter. Ensure unit is in Junir mde. Check xygen surce crrectly cnnected Adjust level f xygen as necessary. Check heated breathing tube fr blckage Ensure water chamber and water bag d nt run ut f water. Change chamber if it has run dry and flat is damaged. Check pwer supply Page 4 f 6
5. Standard checks f a child n AirVO 2 At the beginning f the shift the supprt wrker shuld get a handver frm the family r supprt wrker in attendance. Tgether yu shuld check: Is the child breathing nrmally (fr them)? Are they breathing faster r slwer than nrmal? Are they wrking harder t breathe than nrmal? Is the breathing sfter r shallwer than nrmal Des their breathing sund nrmal fr them? D the settings n the AIRVO2 match the settings prescribed in the child s ventilatin rder Are the nasal prngs r mask prperly cnnected t the child nt t lse, nt t tight? Spare "wiggle pads " available t change as required t ensure prngs secure Hw has the child been? Are they well at the mment? Has there been any change in the child s cnditin since the supprt wrker last cared fr them? If there are any equipment prblems fix them while yu cmplete yur checks, if yu have any cncerns abut the child speak t the child s primary caregiver immediately. 6. Start f shift equipment checks 6.1 AIRVO 2 and circuit Make sure the unit is plugged int the mains AC pwer and the pwer pint switch is n Starting frm the AIRVO 2 check the circuit fr leaks and ensure cnnectins are tight Check fr water (frm excess cndensatin) in the circuit and remve water by tipping it back int the humidifier chamber Using the ventilatin rder make sure that the settings and alarm limits are crrect Check the water level and add water if needed. Make sure the humidifier is lwer than the child (s water can t drain twards the child 6.2 Oxygen Saturatins mnitr (t be used if child is n xygen) refer t xygen saturatins manual Mnitr plugged int mains AC pwer and the pwer pint switch is n Check that saturatin sensr prbe ( Sats-Prbe ) has been repsitined n the child in the last fur hurs. Check that the mnitr is displaying the heart rate and xygen saturatin. Sme mnitrs may als have a trace f saturatin ver time. Make sure the alarm limits are set accrding t the limits n the sats mnitr child specific care page. Page 5 f 6
6.2.1 Oxygen If xygen is required make sure there is enugh xygen equipment (O2 cylinders, cncentratrs, tubing, cnnectrs) fr yur shift and the next shift 6.2.2 Suctin Check that suctin is available, wrking and that the suctin machine is fully charged r charging. Check that the canister and the suctin catheter are clean and the right size fr the child. 6.2.3 Resuscitatin equipment Make sure the resuscitatin bag r mask is available and wrking. If any f the equipment used fr delivering high flw xygen t the child is nt wrking, r needs servicing r repairs, please infrm the parents. The parents will need t arrange t return the equipment t the RCH Clinical Technlgists. 7. Hurly checks The supprt wrker needs t cmplete standard checks f the child every hur r as directed by the child specific care pages (mre frequent checks may be needed). Check the child lks/acts like their usual self Des the child need suctining? Is the circuit prperly cnnected? Is there enugh water in the humidifier? Is the tubing free f water? (cndensatin) Prvide 4 hurly pressure area care (r mre frequently if any pressure areas present) Oral and nasal care must be perfrmed 2 hurly 4 hurly If the child has a nasgastric tube it shuld be aspirated/vented 2-4 hurly fr air Read the child specific care pages fr any ther checks required. During the supprt wrkers shift they may be required t recrd infrmatin frm the ventilatr as directed by the child specific care page/nurse r family. 8. Safety when using a humidifier D nt tuch the heater plate, it can get very ht and cause burns. Always unplug the humidifier when yu aren t using it D nt use a humidifier arund water, e.g. bathing the child If the humidifier falls int water, d nt attempt t retrieve it. Unplug it immediately. Always supervise the child when they are cnnected t a mechanical humidifier Ensure the tubing is free f water if water is in the tubing tip it back t the water chamber nt tward the child. Page 6 f 6