Nursing Procedure Checklist

ADMINISTRATION OF OXYGEN VIA NASAL CANNULA

Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if
skill is not performed correctly; and Not Done if the student failed to perform the skill.
Correctly Incorrectly Not Done
Procedure Done Done
1. Identify the patient.
2. Prepare materials (mask, gauze pads, oxygen tank)
3. Explain the procedure and the reason to the significant
other.
4. Review safety precautions necessary when oxygen is in
use.
5. Perform hand hygiene.
6. Connect nasal cannula to oxygen set-up with
humidification.
7. Adjust flow rate as ordered by the physician.
8. Check if oxygen is flowing out of prongs by placing it
over the surface of your fist or behind your ear
9. If you feel a gush of air, place prongs in newborn’s
nostrils, tubing over and behind each ear and adjust
comfortably under chin or around the patient’s head using
the adjuster.
10. Place gauze pads at ear beneath the tubing as
necessary.
11. Adjust the fit of the cannula as necessary. Tubing
should be snug but not tight against the skin.
12. Reassess patient’s respiratory status, including
respiratory rate, effort, and lung sounds. Note any signs of
respiratory distress, such as tachypnea, nasal flaring, use
of accessory muscles, or dyspnea.
13. Perform hand hygiene.
14. Assess and check nares for evidence of irritation or
bleeding, and oxygen regulation at least every 4 hours or
according to agency recommendations.
15. Document procedure in patient’s chart.

Comment:
__________________________________________________________________________________
____________________________________________________ ____
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Score: _________________________________________________________________

Name of Student: Date Performed:

(Signature Over Printed Name)

Evaluated by: Date of Evaluation:

(Signature Over Printed Name)