Humidified high flow nasal cannula therapy is a form of non-invasive respiratory support which has been compared to continuous positive airway pressure (CPAP). This positive pressure therapy is considered to be in between low flow oxygen devices, such as the nasal cannulas and the CPAP modes and an alternative to the BiPAP modes. At high flows of 30 to 100 liters per minute, using suitable nasal prongs, a positive distending pressure may be achieved to treat hypoxemia.
The high flows and humidification improve functional residual capacity and enhances mucociliary clearance of secretions thereby reducing work of breathing. Gas from an air/oxygen blender that can generate a total flow of up to 60 L/min is heated and humidified with an active humidifier and subsequently delivered through a heated circuit. High flow oxygen works by washing out the carbon dioxide in the anatomical dead space. The system, even when it is delivered through an open system overcomes the resistance of the airways and increases lung volume or recruits collapsed alveoli.
Definition
High flow nasal oxygen or high flow nasal cannula therapy is a type of respiratory support method that delivers a high flow of heated and humidified oxygen/medical gas to a patient through an interface intended to create a wash- out of the upper airway.
Indications
- Respiratory distress.
- Hypoxemia.
- Chronic pulmonary disease.
- Respiratory support for weaning from ventilator or BIPAP.
Contraindications
- Critically low oxygen levels, decreased consciousness, requiring higher level of respiratory support.
- Upper airway obstruction.
- Pneumothorax.
- Trauma to head or airways.
Articles needed
- High-flow nasal oxygen machine.
- Nasal cannula.
- Distilled water for humidifier.
Procedure
| Nursing action | Rationale | |
| 1. | Position nasal prongs from device in nares without completely obstructing nares. | Proper positioning ensures comfort and prevents chances of prongs slipping from nose. |
| 2. | Start high flow at room air oxygen (21%) and slowly titrate up to required dose. | |
| 3. | Ensure humidifier and replace humidifier as needed. | Change of humidifier reduces the risk of infection. |
| 4. | Obtain physician’s order. | |
| 5. | Stop feeding for 2 hours of commencement of device if on a nasogastric tube feeding. Bolus tube feeding or oral nutrition is recommended. | Prevents aspiration and gastric distension. |
| 6. | Perform oral care every 4 hours and as needed. | Prevents dryness of oral mucous membranes. |
| 7. | Monitor patient continuously for response in respiratory rate, heart rate, respiratory distress, SpO2. | Monitoring continuously provides ongoing assessment of patient’s condition. |
| 8. | Monitor for worsening symptoms and alert physician for possible intubation. | |
| 8. | Document findings as per hospital protocol. | Helps to evaluate outcomes and need for changes in therapy. |
| 10. | Constantly update patient and family about changes in condition. | Keeps the patient and family positive about health condition and allays anxiety. |
Complications
- Abdominal distension.
- Pressure injuries.
- Blocked HFNP due to secretions.
- Pneumothorax.
- Mucosal injury due to overheating or drying up of humidifier.
- High flow devices are positive pressure and hence aerosol generating and can spread airborne diseases, such as COVID 19.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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