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1 208 High Flow Therapy- Adult 208/ Page 1 of 6 Description High-Flow O2 therapy is a high flow, high humidity, temperature controlled, non-aerosol, oxygen delivery device. High-Flow O2 therapy may be used via nasal cannula, aerosol mask, trach mask or other narrow-gauge tube (Patient Interface) to deliver O2 therapy to patients 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. 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: Hi-Flow O2 therapy Patient Interface F I O 2 and Liter Flow or desired SpO2 or PaO2 target range.

2 208 High Flow Therapy- Adult 208/ Page 2 of 6 Equipment Needed Obtain High-Flow blender stand from equipment storage room or Draeger XL ventilator. Patient interface (High-flow nasal cannula, aerosol mask, or trach connect) Procedures High Flow Blender device Set up unit David Vinson 1/5/10 5:32 PM Formatted: Heading 2 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 H 2 O 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. Set Flow and F i O 2 per physician order. o Usual flow between lpm for adults. o For High-flow nasal cannula, max flow rate 40 lpm to ensure 100% Relative Humidity. o For other masks, max flow rate 50 lpm. Draeger XL using O2 Therapy Mode Set up (assuming the patient has been on mechanical ventilatory support) David Vinson 1/5/10 5:32 PM Formatted: Heading 2 1. Activate O2 Therapy Mode 2. Set Flow and F i O 2 per physician order. a. Usual flow between lpm for adults. b. For High-flow nasal cannula, Max flow rate 40 lpm to ensure 100% Relative Humidity c. For other masks, max flow rate is 50 lpm

3 208 High Flow Therapy- Adult 208/ Page 3 of 6 Connect to patient 1. Fit nasal cannula, trach direct connect or aerosol mask to patient. Adult cannula comes in small and large sizes. David Vinson 1/5/10 5:33 PM Formatted: Heading 3 DO NOT SUBSTITUE ANY CANNULA OTHER THAN THE LOW RESISTANCE CANNULA DESIGNED FOR HIGH FLOW DELIVERY WITH THIS DEVICE 2. Ensure that nasal prongs do not fit too tightly in nares. a. The prong diameter should be approximately half the diameter of the nares. Note: Humidifier will shut down if power is interrupted, temperature safety limits are exceeded or chamber water runs dry. Troubleshooting Check all connections and MR850 function. High Flow Oxygen Delivery via Aerosol or Trach Mask The following is the procedure for converting the Vision to a high flow oxygen delivery system. This setup can be used on patients that require alternating between Non Invasive Ventilation (NIV) with the Vision and heated humidified oxygen, and eliminates the need for a separate oxygen delivery device. Procedure: 1. Set the Vision in the STD mode. 2. Disabled alarms for Low Pressure, Low Minute Ventilation, and Apnea. 3. Place the Plateau Exhalation Valve at the device outlet (see diagram below). David Vinson 1/5/10 5:36 PM Formatted: Indent: Left: 0", Hanging: 0.38", Space Before: 6 pt, After: 6 pt David Vinson 1/5/10 5:31 PM Formatted: Bullets and Numbering 4. Set IPAP and EPAP to 6 cm H 2 0 to deliver approximately L/min of flow. NOTE: DO NOT USE HIGHER PRESSURE SETTINGS. At higher pressure settings a higher flow rate is delivered, the efficiency of the humidifier decreases, and gas will not be 100% saturated with water vapor. 5. Set FiO 2 to desire level. 6. Attach heated wire circuit to aerosol or trach mask. NOTE: This works only when delivering high flow oxygen through a heated humidifier. If a humidifier is not used the disconnected alarm will remain active. David Vinson 1/5/10 5:36 PM Formatted: Indent: Left: 0", Hanging: 0.38", Space Before: 6 pt, After: 6 pt David Vinson 1/5/10 5:31 PM Formatted: Bullets and Numbering David Vinson 1/5/10 5:35 PM Formatted: Note

4 208 High Flow Therapy- Adult 208/ Page 4 of 6 CAUTION: When returning the patient back to NIV be sure to move the Plateau Exhalation Valve back to the distal end of the circuit and reset the Low Pressure, Low Minute Ventilation, and Apnea alarms. Set Up Diagram: David Vinson 1/5/10 5:36 PM Formatted: Heading 3 Patient Assessment / Reassessment Monitor for humidifier alarm conditions. Repeat every 4 hours. 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

5 208 High Flow Therapy- Adult 208/ Page 5 of 6 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. 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 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 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 with a clean circuit prior to storage in 4F9. Note: Sleeve single limb heated circuit only if rainout is a problem. Charting Document settings and patient tolerance in patient medical record. 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

6 208 High Flow Therapy- Adult 208/ Page 6 of 6 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 Notes: 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. Do not charge for a mechanical ventilator when using O2 therapy mode for High Flow O2. Charge for High Flow O2.

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