208.2 High-Flow Therapy: Pediatric, Infant, Neonatal and Premature 208.2/ Page 1 of 5

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1 208.2 High-Flow Therapy: Pediatric, Infant, Neonatal and Premature 208.2/ Page 1 of 5 Description The High-Flow warms and humidifies air/oxygen blends for high flow delivery to a patient via nasal cannula, mask, trach mask or other narrow-gauge tube greatly improving patient comfort, ease of care and efficiency of gas delivery. The High-Flow technology delivers molecular vapor with nearly 100% relative humidity at body temperature and above. This warmth and humidity expands options to include nasal prongs and trach direct connect without discomfort or damage to airway epithelia. Indications/Use Clinical indications are summarized below: Supplemental Oxygen therapy requirement- Heated humidified gas improves patient comfort and ease of care. Tracheostomy Patients The High-Flow is connected directly to a tracheal mask, collar or transtracheal catheter. Extubation Support- The humidified gas stream has been found helpful to reestablishing normal breathing. Pulmonary Hygiene- Heated humidified gas improves pulmonary hygiene Note: High flow devices meet the total inspiratory gas flow need of the patients and can provide specific FIO2 levels delivered to patient regardless of rate and depth of respiration. FIO2 range with high flow devices is from room air to 1.0. Physician's Order High-Flow O2 Therapy FiO2 Liter Flow Or desired SpO2 or PaO2 range

2 208.2 High-Flow Therapy: Pediatric, Infant, Neonatal and Premature 208.2/ Page 2 of 5 Equipment Needed Obtain High-Flow device (6H dedicated units only) and proper patient interface from 6H equipment room. WARNING: Do not use the high flow delivery systems designated for the Adult population. Fisher & Paykel; part #RT329 includes circuit, chamber, high pressure pop off Procedures Set up unit Critical Patient Safety Notes: i. High pressure pop off and flow restrictor use mandatory. ii. Ensure 6 lpm flow restrictor nipple is placed on flowmeter. 1. Plug in power cord in Red receptacle at bedside and connect air/oxygen source from Hi-Flow blender. 2. Assure no gas leak at any connection point. 3. Spike the Sterile H2O bag, Allow water to fill the F&P chamber. 4. Turn the F&P MR850 unit on and set to the Invasive mode. Unit will reach desired temp within 5 minutes. 5. Adjust flow and/ oxygen FiO2 blend as per physician orders. 6. Adjust flowmeter and FiO2. Usual values: Pedi 5 lpm Infants 2 lpm Neonates and Premature babies </= 2.5 lpm

3 208.2 High-Flow Therapy: Pediatric, Infant, Neonatal and Premature 208.2/ Page 3 of 5 Connect to patient 1. Fit nasal cannula to patient. Cannula sizes: Pediatric / Infant / Neonate / Premature DO NOT SUBSTITUE ANY CANNULA OTHER THAN THE LOW RESISTANCE CANNULA DESIGNED FOR HIGH FLOW DELIVERY WITH THIS DEVICE a. To select a size, the NC prong should be approximately half the size of the nares. i. Ensure that nasal prongs do not fit too tightly in nares. b. Ensure the nasal prongs are positioned at least 2cm from the septum to avoid pressure necrosis. c. Change nasal prongs every 7 days and as needed. Note: Humidifier will shut down if power is interrupted, temperature safety limits are exceeded or chamber water runs dry. Patient Assessment / Reassessment The patient s response to therapy should be assessed and reassessed. Patient assessment and reassessment should be performed according to the general RCS policy (see Section IV - Patient Assessment / Reassessment in the RCS Policy Manual). The need to continue therapy should be reassessed every 24 hours. Specific criteria for assessment and reassessment should include: Changes in oxygenation Changes in secretion clearance Patient s tolerance to therapy Development of the following complications Complications Hypoxia or unwarranted hyperoxygenation if air/oxygen blender is accidentally adjusted. Always analyze F I O 2 before procuring ABG and when checking the device for proper functioning.

4 208.2 High-Flow Therapy: Pediatric, Infant, Neonatal and Premature 208.2/ Page 4 of 5 Gas Temperature too high or too low. Both cases can cause patient discomfort as well as affect the degree of humidification provided to the patient. Adjust the heater or replace the heater if defective. No water in the humidification chamber. If this occurs, the patient would inspire hot dry gas which could lead to extreme discomfort, dried retained secretions and blockage of an endotracheal tube in intubated patients. Pressure ulcer from oversized nasal cannula Discontinuation Procedures Weaning from High Flow Nasal Cannula There is no available study data regarding weaning from High-Flow O2 therapy adjust per patient tolerance: 1. Pediatric: wean FiO2 first and Flow second. 2. Infant: wean FiO2 first and Flow second. 3. Neonate: wean FiO2 first and Flow second. 4. Premature: wean FiO2 first and Flow second Equipment Shutdown 1. If still connected, remove interface from patient. 2. Press the MR 850 power switch once. (Verify unit turns off). 3. Disconnect the gas sources, and turn off flowmeter. 4. Dispose of circuit in the Infectious Waste (Red bag) receptacle, filters and water reservoir in regular waste receptacle. 5. Disinfect exterior of unit by wiping down with disinfectant solution. 6. Set up unit with a clean circuit. 7. Return to NICU 6H equipment storage room. Note: Sleeve single limb heated circuit only if rainout is a problem.

5 208.2 High-Flow Therapy: Pediatric, Infant, Neonatal and Premature 208.2/ Page 5 of 5 Charting Also see Section 100 Oxygen Therapy. Document settings and patient tolerance in the appropriate RCS documentation related to the care area. Monitor for humidifier alarm conditions. Charges Charge in Invision for one of the following physician-ordered high flow delivery devices when therapy is started: High Flow Nasal Cannula High Flow Trach Mask High-Flow T-Piece High Flow Mask Charge in Invision for one of the following each time you change the High- Flow Circuit, High Flow T-piece, or High Flow Nasal Cannula: High-Flow Nasal Cannula Change High-Flow-Trach Mask Change High Flow T-Piece Change High-Flow Mask Change Note: Do not charge in Invision if you only change a Mask, Trach Mask. These items should be charged to the patient in the Omni cell.