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High Flow Nasal Cannula (2.22)

High Flow Nasal Cannula (2.22) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Oxygen Therapy

2.22

UNIVERSITY OF WISCONSIN HOSPITAL & CLINICS
POLICY & PROCEDURE
U.
W.
H.
C.
Date: April 2015 Original
X Revision
Page 1
of 2
Policy #
2.22
X Respiratory Manual

Title: High Flow Nasal Cannula (HFNC)

I. PURPOSE:

To safely and effectively apply high flow blended oxygen, with heated, humidified nasal cannula therapy.

II. CONTRAINDICATION:

Facial Trauma

III. POLICY:

A. All patients will be assessed by the Respiratory Care Practitioner (RCP) to determine if the
appropriate indications for therapy are present.
B. Therapy will be provided in accordance with a provider’s order
C. Acute patients receiving high flow nasal cannula will be in an ICU or IMC.
D. Hi flow can be initiated on general floor care areas:
1. B6/6 for patients on the Palliative Care service or patients being consulted by the
Palliative Care Service.
2. AFCH patients who are receiving end of life care.
3. Patients waiting for transfer to an ICU or IMC.
E. Pediatric ICU patients on high flow nasal cannula with a stable or improving respiratory
condition may be transferred to the floor on one of the following services:
Hospitalist, Hem/Onc or Pulmonary.
1. Transfer will be determined in collaboration with the ICU attending and the receiving
service.
2. PICU attending or fellow will discuss the patient daily as needed or requested by the
receiving service.
3. If respiratory condition worsens or care cannot be supported to meet the patient’s needs,
the patient will transfer to an ICU or IMC.
F. The RCP will assess the patient at a minimum of every four hours.
G An RCP will accompany a patient on HFNC who are transferred off the unit for any reason.

IV. EQUIPMENT:

A. Heated wire humidifier with circuit using the invasive mode
B. Nasal interface
C. Sterile Water
D. Air/Oxygen blender
E. Oxygen analyzer

V. PROCEDURE:

A. Review and acknowledge provider’s order.
B. Review patient’s chart.


U.
W.
H.
C.
Date: April 2015 Original
X Revision
Page 2
of 2
Policy #
2.22
X Respiratory Manual

Title: High Flow Nasal Cannula (HFNC)

C. Obtain the appropriate equipment.
D. Introduce yourself to the patient &/or family. Explain the reason for the procedure.
E. Place the patient on the high flow heated nasal cannula and assess the patient.
F. Adjust the flow and FIO2 to desired levels based on patient’s work of breathing and oxygenation.
G. Wean the FIO2 to desired oxygen saturations before weaning flow.
1. Pediatrics:
a. Less than one year: wean FiO2 by 5% < 30%, then wean flow by 0.5-1.0 lpm.
b. Greater than one year: wean FiO2 by 5% to 35%, then wean flow by 1 lpm.
2. Adult: wean FiO2 to 35%, then wean flow by 5 lpm until the liter flow is 10 lpm.
3. Patient can be trialed off HFNC if desired

VI. REFERENCES:

A. Respiratory Care Services P&P;
1. #1.40 Cleaning and Changing of Patient Care Equipment
2. #2.18 Oxygen Therapy
3. #2.21 Aerosol and/or Humidity Therapy
B. Nursing P&P #7.21, HFNC for Pediatric Patients
C. U-connect related links
1. Pediatric high flow nasal cannula system
2. Adult high flow nasal cannula system




Approved by Director and Medical Director of Respiratory Care:

Original copy of this Policy & Procedure is available in the Respiratory Care Office located [E5/489].