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AARC Clinical Practice Guideline - Respiratory Care

AARC Guideline : NEONATAL ANDPEDIATRICO2 DELIVERY707 RESPIRATORYCARE JUNE2002 VOL47 NO6 NPODD PROCEDURE:The selection of an oxygen delivery system forneonatal and pediatric patients includes patientswith and without artificial DESCRIPTION:The administration of supplemental oxygen toneonatal and pediatric patients requires the selec-tion of an oxygen delivery system that suits the pa-tient s size, needs, and the therapeutic goals. Oxy-gen delivery systems are categorized as either low-flow (variable performance) or high-flow (fixedperformance) provide an FDO2(fractional concentration of delivered oxygen) thatvaries with the patient s inspiratory flow and areclassified as variable-performance oxygen systems can provide a specificFDO2at flows that meet or exceed th

AARC GUIDELINE: NEONATAL AND PEDIATRIC O2 DELIVERY RESPIRATORY CARE •JUNE 2002 VOL 47 NO 6 709 catheters are contraindicated in patients with nasal obstruction (eg, nasal polyps, choanal

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Transcription of AARC Clinical Practice Guideline - Respiratory Care

1 AARC Guideline : NEONATAL ANDPEDIATRICO2 DELIVERY707 RESPIRATORYCARE JUNE2002 VOL47 NO6 NPODD PROCEDURE:The selection of an oxygen delivery system forneonatal and pediatric patients includes patientswith and without artificial DESCRIPTION:The administration of supplemental oxygen toneonatal and pediatric patients requires the selec-tion of an oxygen delivery system that suits the pa-tient s size, needs, and the therapeutic goals. Oxy-gen delivery systems are categorized as either low-flow (variable performance) or high-flow (fixedperformance) provide an FDO2(fractional concentration of delivered oxygen)

2 Thatvaries with the patient s inspiratory flow and areclassified as variable-performance oxygen systems can provide a specificFDO2at flows that meet or exceed the patient s in-spiratory flow requirement and are classified asfixed-performance oxygen delivery Low-flow cannulas consist of two softprongs that arise from oxygen supply prongs are inserted into the pa-tient s anterior nares, and the tubing is se-cured to the patient s face. Oxygen flowsfrom the cannula into the patient s na-sopharynx, which acts as an fractional concentration ofinspired oxygen (FIO2) varies with the pa-tient s inspiratory catheters are softtubes with several distal holes.

3 Thecatheter should be inserted into the pa-tient s nose to a depth equal to the dis-tance from the ala nasi to the tragus5or begently advanced and then withdrawn untilit rests slightly behind the , secured to the patient s face, is con-nected to oxygen supply tubing. Oxygenflows from the catheter into the patient soropharynx, which acts as an FIO2varies with the pa-tient s inspiratory oxygen adapters aredevices that attach either directly to a tra-cheostomy tube or to a heat-moisture ex-changer (HME), which is then attached tothe tube.

4 (HMEs or artificial noses col-lects a patient s expired heat and moistureand returns it during the following ) The oxygen supply tube connect-ed to the adapter provides a blow-bysource of oxygen that results in a variableFIO2. These devices are intended for shortperiods such as brief transports or to in-crease patient catheters are devicesthat delivery gas directly into the tracheavia a small percutaneous catheter held inplace with a bead chain Reservoir oxygen masks are plasticreservoirs designed to fit over the pa-tient s nose and mouth and be securedaround the patient s head by an increased reservoir effect isproduced by adding the volume of is delivered through asmall-bore tube connected to the base ofthe mask.

5 Holes on each side of the maskprovide an egress for exhaled gases andserve as room-air entrainment with the patient s inspiratoryflow, mask fit and patient Respiratory , masks are simi-lar to simple oxygen masks but contain areservoir at the base of the receives fresh gas plus exhaledgas approximately equal to the volume ofthe patient s anatomic dead Clinical Practice GuidelineSelection of an Oxygen Delivery Device for Neonatal and Pediatric Patients 2002 Revision & UpdateRETIREDAARC Guideline : NEONATAL ANDPEDIATRICO2 DELIVERY708 RESPIRATORYCARE JUNE2002 VOL47 NO6oxygen concentration of the exhaledgases combined with the supply of freshoxygen, permits the use of flows lowerthan those necessary for other devices (eg,non-rebreathing masks)

6 , and potentiallyconserves oxygen masks are similarto partial-rebreathing masks but do notpermit the mixing of exhaled gases withthe fresh gas series of one-way valves ensures a fresh oxygen supplywith minimal dilution from the entrain-ment of room one-way valveover the reservoir bag prevents entry ofexpired gas, and the one-way valve overone of the side ports limits entrainment ofroom design provides a higherFIO2than the simple and partial-rebreath-ing masks and the nasal devices providingthe mask fits air-entrainment mask contains ajet orifice and air entrainment ports and isdesigned to fit over the patient s nose andmouth and is connected to oxygen under pressure is forcedthrough a small jet orifice entering themask.

7 The velocity increases causing ashearing effect distal to the jet orifice,which causes room air to be entrained intothe total flow provided by themask is determined by the cross-sectionalarea of the entrainment ports, the diameterof the jet orifice, and the oxygen flow tothe jet. The FDO2is determined by the di-mensions of the jet and the entrainmentports. The entrainment mechanism isbased on the principles described collar can be attached tothe base of the corrugated hose for supple-mental humidification,13and the devicecan be adapted to a tracheostomy nebulizers are gas-powered, large-volume nebulizers thatcontain an adjustable air-entrainmentport, which determines specific ,14In addition to provid-ing particulate water with or withoutadded medication.

8 Heated nebulizers candeliver gas saturated with water vapor atbody corrugated hoseserves as a conduit from the nebulizer toan aerosol mask, face tent, tracheostomycollar, or hoods are transparent en-closures designed to surround the head ofthe neonate or small ,16A continu-ous flow of humidified oxygen is suppliedto the ,16 Transparent enclosures inlarger sizes (so-called tent houses or huts)are available for patients who are too bigfor neonatal-size incubators are transparentenclosures that provide a warm environ-ment for small infants with oxygen can beadded to incubators but may result in anincreased oxygen purpose of an incubator is to pro-vide a temperature-controlled environ-ment.

9 Humidification is available througha baffled blow-over water reservoir; how-ever, due to the high risk of infection as-sociated with this humidification system,alternative sources are ,the incubator is not further discussed as anoxygen delivery SETTING:Oxygen delivery devices are used in a number ofsettings including hospitals, clinics, extended carefacilities, the home, and patient transport INDICATIONS:The selection of an oxygen delivery device is indi-cated hypoxemia17, acute situation in which hypoxemia issuspected or in which suspected regional hy-poxia may respond to an increase in PaO2.

10 Sub-stantiation of PaO2is required within an appro-priate period of time following initiation ,18 NPODD specific contraindications to deliveringoxygen exist when indications are judged to cannulas and nasopharyngealRETIREDAARC Guideline : NEONATAL ANDPEDIATRICO2 DELIVERY709 RESPIRATORYCARE JUNE2002 VOL47 NO6catheters are contraindicated in patients withnasal obstruction (eg, nasal polyps, choanalatresia, etc). catheters are contraindicat-ed in the presence of maxillofacial trauma,19inpatients in whom a basal skull fracture is pre-sent or suspected,18or coagulation is the expert opinion of the Clini-cal Practice Guideline Steering Commit-tee (2002) that nasopharyngeal cathetersare not appropriate for oxygen adminis-tration in the neonatal opinions vary,21-24infants intubat-ed for airway protection should probably beplaced on CPAP (ie, physiologic CPAP)


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