POLICY

Policy Area: PULMONARY DEPARTMENT

Policy Title: HIGH FLOW OXYGEN THERAPY (AIRVO²)

SET UP
Document Code: Revision No.:
AS-PUL-0006 1

Issue No.: Issue Date: Review Date: Page :

1 October 21,2021 October 21, 2024 1 of 4

Issued to:
NSO Department

1. RATIONALE AND POLICY STATEMENT

To define the responsibilities of Respiratory Therapists and Pulmonary Nurses
with validated competency in handling a High Flow Nasal Cannula Machine and
to ensure safe use of High Flow Oxygen.

2. RESPONSIBILITY
2.1 Respiratory Therapists - person with appropriate knowledge and training
can select patients for this therapy, set up the equipment, establish patients on
the therapy, make adjustments to the settings and wean the patient from the
therapy.
2.2 Nursing Staff - all trained nurses responsible for a patient on this therapy
should have appropriate training to manage the machine, monitor patient and
respond to any issues.
2.3 Respiratory consultants and registrar- responsible for prescribing oxygen
and target saturations and making decisions regarding patient selection for this
therapy. Responsible for ensuring that the patient has an up to date Treatment
Escalation Plan.

3. ABBREVIATIONS
HFNC - High Flow Nasal Cannula
PPE - Personal Protection Equipment
LPM - Liters Per Minute

4. DEFINITIONS
4.1 High Flow Nasal Therapy system is a System which delivers heated,
humidified high flow oxygen therapy via nasal cannula or tracheostomy
attachment.
4.2 High flow nasal cannula (HFNC) is a widely used modality of delivering high
concentrations of oxygen and airflow to patients with hypoxemic respiratory failure,
but its use in patients with SARS-CoV-2 is poorly described.

5. SCOPE OF THE POLICY

ECG is done in OPD, ER and in Wards.

6. POLICY STEPS
6.1. Check the doctor’s order
6.2. Prepare the machine and items needed.
6.3. Greet the patient and introduce yourself.
6.4. Identify the patient by asking his Complete Name and Date of Birth.
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6.5. Explain procedure to patient or relative and gain consent.

6.6. Wash hands and wear appropriate Personal Protection Equipment (PPE) in
line with infection control policy.
6.7. Assemble equipment as per manufacturer’s instructions. Label equipment
with date for tubing change (according to manufacturer’s instructions). All
disposable components are single patient use. Select appropriate patient
inter-face. Switch equipment on, connect oxygen supply if required and
check it is ready for use (check disinfection status).
6.8. Perform sounding alarm test by disconnecting tube from top of machine to
check that alarm sounds.
6.9. Adjusting settings
6.9.1. Press any button to enter the summary screen. Select temperature
using the arrow right button. Press and hold down both the up and down
arrows at the same time to unlock the screen. Use up and down arrows
to select desired temperature. Ideally should be set at 37◦C as this will
provide optimum humidification but this may not be comfortable so either
34 or 31◦C may be selected, if a mask is used then temperature should
be set at 31◦C.
6.9.2. Press the arrow right button to select flow rate screen. Unlock screen
as above. Use up and down buttons to select required flow rate. Most
patients with type 1 respiratory failure would commence with at least 40
LPM flow.
6.9.3. Press the arrow right screen to access oxygen percentage and use the
attached flow meter to adjust the percentage of oxygen until required
patient saturations are reached. The screen does not require unlocking to
adjust the oxygen percentage.
6.9.4. It is important to note that if the flow rate is adjusted then the oxygen
percentage will also change and will therefore need adjusting at the
oxygen flow meter.
6.9.5. Patients with a laryngectomy or tracheostomy that require
humidification but not oxygen can receive humidified air. In this instance
it is not necessary to connect the oxygen supply. Follow the guidelines
for setting of temp and flow rate as above.
6.10. Monitoring patient
6.10.1. Oxygen delivery should be recorded in patients notes and on the
chart as both percentage and flow rate.
6.10.2. The equipment should be checked at least four times daily and
this recorded on chart. The machine should be visually inspected. The
settings should be noted and recorded on the chart and in checklist.
6.10.3. The settings of the machine can easily be checked by pressing
any button on the machine and it will then display temp/ flow rate and
oxygen percentage. Oxygen percentage can be adjusted with the flow
meter without the need to unlock the screen.
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6.10.4. Any increases in oxygen requirement from those set should be

performed by a trained member of staff and an increasing need for
oxygen should be escalated to the medical team.
6.10.5. As patient’s condition improves the oxygen percentage should
be decreased first before decreasing the flow rate.
6.11. Cleaning of equipment
6.11.1. Once therapy has been discontinued discard all disposables in
appropriate waste.
6.11.2. Clean as per manufacturer’s instructions including a disinfectant
cycle.

7. REFERENCE/S:

7.1. Fisher & Paykel (2006) OptiflowTM humidification review.

www.fphcare.com
7.2. 7.2. Parke RL, McGuiness SP, Eccleson ML (2011) A preliminary
randomised controlled trial to assess effectiveness of nasal high-flow
oxygen in intensive care patients. Respiratory Care; 56(3): 265-270
7.3. Roca O, Masclans JR, Laborda C, Sacanell J, Serra J (2007) High-flow
nasal canula improves oxygen administration in hypoxemic respiratory
failure (abstract). Intensive Care Medicine; 33
7.4. Roca O, Riera J, Torres F, Masclans JR (2010) High-flow oxygen therapy
in respiratory failure. Respiratory Care;55(4), 408-413

8. ATTACHMENT/S:
Not Applicable

9. DEVELOPMENT TEAM:
9.1 Brian Abner Recio, RN

9.2 Mary Joy Sy, RN RMT

10. APPROVAL:
Prepared By: Reviewed By: Approved By:

Brian Abner Recio, RN Edward Jeremy Miranda Grace M. Aba

Pulmonary Unit Head Ancillary Serviced Director President & CEO

11. REVISION HISTORY:

(This part is being update whenever a revision was made.)

Revision No. Revision Description
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Original Original Document, No revision/s has been made.

12. END OF DOCUMENT: