OXYGEN - Carer Skills Passport



Oxygen

Information

Manual

For Use in

School / Nursery

Carol Lawrence

Oxygen Nurse Practitioner

Alder Hey Children’s NHS Foundation Trust

August 2014

CONTENTS

Page

1. Introduction and Respiratory System 3 – 4

2. Oxygen Equipment 5 – 13

3. Nasal Cannulae 14

4. Tracheostomy 15

5. Oxygen Safety 16

6. Storage of Oxygen Cylinders 17

7. Transport 17

8. Procedure in the Event of a Fire 18

9. Problems 9-20

10. New patient checklist 21

11. Child’s Personal Details Form

Oxygen and Suction Care Plan 22-23

12. Oxygen Cylinder Check Form 24

12. Staff Training List 25

13. ‘Education for Carers – Administration of Oxygen’ 26- 31

14. ‘Education for Carers – Administration of Oxygen

Competencies' 32-33

15. Useful Addresses 34

16. Article / Reference List 35

Introduction

As a result of modern medicine, children with complex problems are now being routinely discharged home from hospital and cared for at home (Boosfield and O’Toole 2000). Many of these children have respiratory problems, requiring long-term oxygen therapy (Table1) and home oxygen has resulted in infants and children being discharged home much earlier. Previously these infants and children had to remain in hospital on neonatal and paediatric wards, which had major effects on social interaction and normal family life.

Respiratory System

The main function of the respiratory system is to provide the body with a supply of oxygen and excrete carbon dioxide. Oxygen is transferred to the blood from the air, carbon dioxide is removed from the blood to the air and the exchange of these gases is called respiration. Effective and efficient exchange depends upon all parts of the respiratory system and any chronic or acute disease of these parts may impair gas exchange.

Figure 1. The Respiratory System

In the upper airway, air enters the lungs through the nose and mouth, to reach the pharynx [back of the throat], passes through the larynx [voice box] and into the trachea [windpipe].

Air is warmed and humidified and large particles of dust are filtered out as it passes through the nose. Mucus that comes from the tissues that line the airways will become dry, hardened or thickened causing a blockage if it is not warmed and humidified.

In the lower airways, the trachea divides into two main bronchi, and then subdivides into smaller bronchi. This division continues until bronchioles end in alveoli and this is where gas exchange takes place. The alveolus is only one cell in thickness and in contact with the blood, so oxygen can diffuse from the alveolus to the blood and carbon dioxide from the blood to the alveolus.

The diaphragm and intercostal muscles are the main muscles used in breathing. When the diaphragm contracts it pulls down and air enters the lungs. The intercostal muscles are attached to the ribs and increase the capacity of the chest by pulling the ribs upwards and outwards.

The heart pumps blood to the lungs and the body. If a child has heart problems, gas exchange may be inadequate and therefore supplemental oxygen required

Disorders affecting the Respiratory System

Diseases may affect any part of the respiratory system, causing poor gas exchange and below are some common examples.

1. Disorders that affect the upper airways:

• abnormalities of the larynx, trachea or bronchi eg. stenosis [narrowing], blockage [tumour/ swelling] or abnormal floppy airways.

• structural abnormalities of the oral or nasal cavities eg. cleft palate, coanal atresia [blocked nasal passages]

2. Disorders that affect the lower airways:

• asthma

• cystic fibrosis, which causes increased amount of thick mucus in the lungs and airways.

• swelling, scaring and other structural blockages.

3. Disorders that affect the alveoli:

• bronchopulmonary dysplasia

• pneumonia

• pulmonary toxicity from chemotherapy treatment

4. Disorders that affect the respiratory muscles:

• degenerative muscle disorders eg. muscular dystrophy

• spinal cord injuries

5. Disorders that affect the stimulus to breathe:

• brain damage from trauma eg. drowning, suffocation, birth problems

• certain neurological diseases

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|Principle Paediatric Conditions requiring Long Term Oxygen Therapy (LTOT) |

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|Chronic Neonatal lung Disease (Bronchopulmonary Dysplasia) |

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|Other Neonatal Condition (eg. Pulmonary hypoplasia) |

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|Congenital Heart Disease with pulmonary hypertension |

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|Pulmonary Hypertension secondary to pulmonary disease |

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|Interstitial Lung Disease |

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|Obliterative Bronchiolitis |

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|End Stage Cystic Fibrosis and other causes of severe bronchiectasis |

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|Obstructive Sleep apnoea syndrome and other sleep related disorders |

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|Neuromuscular conditions requiring non invasive ventilation |

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|Disorders of the chest wall (eg. Thoracic dystrophy, severe kyphoscoliosis) |

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|Palliative Care for symptom relief |

Table 1. Balfour-Lynn IM, Primhak RA, Shaw NJ (2005).

Home oxygen for children: Who, how and when? Thorax: 60, 76-81

Supplemental Oxygen

Oxygen reduces the workload on the heart and relieves shortness of breath. When caring for a child requiring supplemental oxygen it is important to be aware of their underlying condition and the possible problems associated with the condition and their treatment. The care requires a knowledge of all the equipment used, oxygen required [L/min], oxygen safety, child's baseline observations including colour, pulse and respiratory rate and what to do in an emergency is essential.

Oxygen Equipment

From 2nd July 2012, new contract for oxygen provision for home started, the oxygen company changed to Air Liquide.

The aims of this new service is to provide a better quality of life for patients, improved ambulatory oxygen, better holiday provision across the UK, improved safety measures and eliminates postcode prescribing.

Air Liquide is the company providing oxygen in the North West area.

Air Liquide have a variety of different oxygen equipment available, including:

Oxygen Concentrators

Static and portable cylinders with integrated valves

Conservers (not used for oxygen flows less than 1L/min and not used for children)

Liquid Oxygen

Associated consumables (nasal spec’s / masks etc)

Oxygen Concentrator

16 What is an Oxygen Concentrator?

Most children will have an oxygen concentrator installed at home to administer their oxygen requirement. An oxygen concentrator is a machine operated by electricity, weighing approximately 25kg (55lb). The machine draws in air from the room atmosphere, separates the oxygen from the other gases in the air and delivers oxygen to the child. It is simple and easy to use.

Oxygen concentrators are not generally used in schools because:

1. They are noisy, therefore can disturb children in a classroom setting.

2. The concentrators are installed in one room, therefore there are problems concerning trailing oxygen tubing and health and safety issues to be considered.

3. Children in school move around for different lessons and activities therefore concentrators are not practical and a portable oxygen delivery system is more suitable.

If a child has high oxygen requirements then a concentrator in school can be considered, however liquid oxygen (p.13) may be more suitable.

Air Liquide have two different oxygen concentrators available:

➢ Airsep Newlife : Standard flow 1– 5 L/min (max use 4Lmin)

[pic]

Figure 2. Air Liquide oxygen concentrator

The engineer will service the concentrator every 6 months and between these service dates you are required to clean and change the air filter on the machine. The filter should be washed weekly in warm water, allowed to completely dry before replacing in the machine.

Emergency Backup Service

If a concentrator is supplied for use at school the company will also supply a back-up emergency cylinder. If there are any problems with the oxygen concentrator, you are advised to use the back up supply and contact the company. Some problems can be resolved with advice over the telephone; however the company do guarantee to call out if the problem persists and before the back up cylinder runs out.

Further information for parents and carers

1. The concentrator can be slightly noisy.

2. It can also warm the surrounding room air, which is not generally a problem in our British climate!

3. The concentrator will only work if there is an electricity supply.

4. Be prepared for any electricity cuts in your area. If there is an electricity cut, use the back up emergency oxygen cylinder or the child’s portable oxygen cylinder. If the electricity is off for a long period then contact the family to collect their child from school.

5. The engineer will take a reading from the concentrator at each service to calculate the amount of hours / electricity used. Air Liquide will then refund the cost, usually by direct payment.

6. Switch off the machine when not in use.

Static cylinders

Air Liquide provide static cylinders for patients requiring less than 1L/min of oxygen, these cylinders have integrated values to allow for a micro flow and low flow regulator to be fitted to given oxygen requirements between 0.01L/min – 1L/min.

➢ M11HQ static cylinder

➢ HC10 static cylinder

➢ HC10H static cylinder

Portable Oxygen Cylinders

➢ What are portable oxygen cylinders?

If you child requires oxygen during the day they will need to use portable oxygen cylinders so that you can go out.

Air Liquide provide different portable oxygen cylinders and provide carry bags for these cylinders. These cylinders are lightweight and have an integral flow regulator.

➢ Lightweight portable 1L cylinder

➢ HC02M portable cylinder

➢ High Flow M02HQL portable cylinder

Re- Ordering Air Liquide Oxygen Cylinders

The quantity of cylinders required each week will depend on the oxygen flow and amount of time (hours) that the child is away from their home. It is important that the child has enough cylinders each week so that they can participate in normal activities, including attending school.

• Parents need to ring Air Liquide on 0808 143 9992 to order more portable cylinders.

• Air Liquide will organize delivery of these cylinders within the standard delivery time of 3 working days.

• Air Liquide will collect the empty cylinders when delivering a new order.

• Parents need to ensure that they do not run out of cylinders. They need to constantly check their supplies ensuring they ring before they run out of cylinders.

Leaks

• Any leakage of oxygen from a cylinder will be evident by a hissing noise. Slight leaks may not always be obvious therefore regular checks of the contents gauge need to be made.

• Leaks most commonly occur at points where attachments are connected to the cylinder

• Never use any kind of sealing compound or sticky tape to cure / fix a suspected leak

• Never attempt to repair a cylinder, other than gentle tightening of joints or attachments

• In the event of a leak, do not use the cylinder. Transfer the cylinder to a safe well-ventilated area, generally outside. Give faulty cylinder to parents asking them to ring Air Products to collect the cylinder, ensuring that they know the cylinder is faulty

• Use the spare oxygen cylinder available, ensuring that your child continues to receive supplemental oxygen. Make arrangements for the spare cylinder to be replaced.

Static Cylinders

[pic] [pic]

[pic][pic][pic]

Portable Cylinders

[pic][pic]

[pic][pic]

Mirco Flow / Low Flow regulators

[pic]

[pic]

Liquid Oxygen

➢ What is Liquid oxygen

Liquid oxygen consists of a large container or ‘dewar’ (figure 6) containing liquid oxygen, which is installed in the child’s home and a smaller portable unit (figure 6), which is used to go out.

The portable liquid oxygen unit is designed to provide oxygen for extended periods away from the home. Parents decant oxygen from the larger container to the portable unit. The portable unit has a higher oxygen capacity than the Freedom oxygen gas cylinders, therefore will last longer for children on high oxygen requirements.

[pic][pic][pic]

Figure 6. Liquid oxygen container (dewar)

Liquid oxygen portable unit

Liquid oxygen is suitable for children requiring high oxygen requirements and who are away from the home for long periods and therefore extremely useful when children attend school.

Important safety instructions

Always keep portable unit upright

Never cover the portable unit or carry under clothing

Always keep the portable unit in a well ventilated area

For further information refer to Air Liquide ‘Your guide to using liquid oxygen’

Nasal Cannula / Spec’s

What are Nasal Cannula/ Spec’s

Nasal cannula are used to deliver a low to moderate concentration of oxygen and are easily applied as long as the child’s nasal passages are open. Eating, talking and coughing are all possible. It is advised to change the nasal cannula every seven to ten days. The small tubes should be soft and pliable and to avoid soreness around the nose they should be inspected regularly. If they do become blocked with mucus, hard or discoloured they should be discarded and a new set used. The use of petroleum based creams (eg. Vaseline) around the nose should be avoided, as these react with oxygen and may cause soreness. Water based creams such as E45 can be used if required.

Nasal cannula are supplied by Air Liquide (the oxygen company). When the oxygen equipment is installed the company will leave enough nasal cannula with the family for use until the next service date (6 monthly). If thee family run out of nasal cannula they need to ring Air Products to order more and they will receive them by post.

There are four different sizes of nasal cannula:

1. Neonatal 2. Infant 3. Paediatric 4.Adult

Securing Nasal Cannula

The nasal cannula may need to be secure onto the child’s face to ensure that the tubing does not become dislodged. For children requiring continuous oxygen the tapes used are called Duoderm (extra thin granuflex) and Mefix (white gauze tape) or Blenderm clear tape). Duoderm is applied directly to the skin under the nasal cannula tubing to provide some cushioning and must be renewed weekly at the same time that the nasal cannula are changed. The nasal cannula are then correctly positioned on the child's face with the prongs into each nostril and secured with Mefix. The Mefix is placed over the tubing and on top of the Duoderm. The Duoderm is left in place and the Mefix can then be changed as frequently as required without pulling the tape directly off your child's skin.

Some older children may not need the nasal cannula securing with tape, as the cannula tubing can be looped over their ears and the toggle pulled taught but comfortably behind their head.

Tendergrips are small round stickers, which can be used if the child has very sensitive skin, eczema or any allergic reactions to the other tapes. These are not available on prescription or from local chemists. Contact Gaynor Harrison, O2 Nurse Specialist for further information.

Figure 7. Duoderm and Mefix (white gauge tape) Figure 8. Tendergrip stickers

(or Blenderm -clear tape)

Oxygen via a tracheostomy

Figure 9. Swedish nose and green portex tubing

Figure 10. Trachphone

Trachphone

Platon Medical Ltd

Tel: 01323 431930

Fax: 01323 732606



Oxygen Safety

[pic]

Oxygen is a colourless and odourless gas, which is slightly heavier than air. The presence of oxygen within a building can increase the risk of fire. Oxygen itself is not flammable but may support and accelerate combustion and cause substances to ignite more easily and burn more fiercely.

Here are a few simple precautions that are needed when using oxygen.

DO NOT SMOKE NEAR ANY OXYGEN EQUIPMENT. THIS INCLUDES THE USE OF E-CIGARETTES AND E-CIGARETTE ARE NOT TO BE CHARGED ANYWHERE IN THE VICINITY OF OXYGEN EQUIPMENT.

DO NOT use the equipment near a fire or naked flames.

DO NOT use grease or oil to lubricate or to come in contact with the oxygen

cylinders, liquid oxygen, valves or fittings.

DO NOT handle equipment with greasy hands.

DO NOT store oxygen cylinders in the same place as paint, petrol, and paraffin, heating gas or other flammable materials.

DO NOT let children play or untrained persons tamper with the oxygen

equipment.

DO NOT hang clothes over the concentrator or oxygen cylinders.

DO NOT let a concentration of oxygen build up in a confined space.

DO NOT use petroleum based creams (eg. Vaseline) around the nose and should be avoided, as these react with oxygen and can cause soreness. Water based creams avoided such as E45 can be used if required.

DO contact the local fire department officer requesting free fire safety advice. Air

Products will automatically inform the fire service that oxygen is installed in

the child’s home, but a school would need to contact the fire service directly.

DO have a full understanding in the use of all the equipment and know who to

contact if the equipment is faulty

DO return defective equipment for replacement.

DO be careful that the oxygen tubing does not become kinked, blocked,

disconnected or punctured.

DO ensure oxygen cylinders are stored securely where they cannot fall or be

knocked over.

DO store oxygen cylinders away from heaters, radiators and hot sun.

DO ensure a spare cylinder is available for emergency use.

DO keep oxygen supplies at the lowest possible level required.

School safety reminder

❖ In school be aware of using paints, massage oils, aromatherapy oils, candles and during cookery lessons (if using gas cookers).

Storage of Oxygen Cylinders in School

Oxygen cylinders should only be stored in school where oxygen is required for medical purposes. Children requiring supplemental oxygen will come to school daily with their own portable oxygen cylinder from home. It is advised that at least one spare cylinder should be stored on the school premises for emergency use (for use if their own cylinder is faulty or the child requires an increased flow).

Oxygen Cylinders should be:

• Stored in a dry, clean and well ventilated area

• Stored under cover, not in the open or exposed to extremes of heat or cold

• Store in a locked area eg. First aid / treatment room or cupboard. The door should be clearly marked with the 'non flammable gas' oxygen symbol (Appendix 1) as a warning of the contents and a need for caution. Please contact Air Liquide 0808 143 9992 if more stickers are required.

• Stored away from flammable liquids, combustible materials and sources of heat and ignition.

• Not be allowed to become rusty or dirty, be repainted or have their markings obscured.

Transport of Oxygen Dependent Children

1. Establish the mode of transport that the child will use to get to and from school, including the transport used for out of school activities or school trips.

2. Inform the vehicle owners to contact their insurance company and inform them that they will be carrying oxygen cylinders.

3. The oxygen cylinders MUST BE SECURED during transport. They should not be allowed to move about freely in the vehicle. Elastic luggage straps, which are cheap and versatile can be used or if available or secure the cylinder using a spare safety belt. Do NOT leave cylinder hanging on the back of a child’s wheelchair without being secured.

Fire Safety

Inform the fire service that oxygen equipment is stored on the school / nursery premises

Freephone 0800 731 5958

Procedure in the Event of Fire

In the event of a fire it is stressed that the safety of all personnel MUST be the first priority.

Initial Actions

• Staff should be aware of the fire procedure for the establishment.

• As soon as a fire is discovered, immediately operate the fire drill and notify the fire services, warning them of the presence of compressed gas cylinders or liquid oxygen.

• Cylinders involved in a fire may burst due to excessive heat and therefore the immediate area must be evacuated.

• Evacuate the premises.

Subsequent Actions

• Cylinders stored in areas which are not directly involved in the fire should be moved to a safe location, provided it is safe to do so.

• Do not attempt to fight a fire in which cylinders are directly involved.

• Do not take any undue risks.

After a fire

• The fire services should be informed of any cylinders, which have been involved in a fire. They should be identified, segregated from other cylinders, should not be used and returned to the supplier for examination.

Problems

RESUSITATION TRAINING IS REQUIRED

Check list for schools

| |Action |Date |Sig |

| | | | |

|Information about the |Complete the 'Child Personal Details' form (p.22-23). | | |

|child |Ensure a copy is kept with the child's school medical records | | |

| |Spare copies are available at the back of the manual. | | |

| | | | |

|Oxygen Equipment / Safety |Identify key trainer / assessor | | |

|Training |Make a list of the staff involved in the child’s care (p.25). | | |

| |All staff / carers who are responsible for caring for an oxygen dependent child must complete | | |

| |training in the use of oxygen. | | |

| |Organise a teaching session using The ‘Oxygen Information for use in Schools Manual’ is | | |

| |available as an educational resource. | | |

| |'Education For Carers – Administration of Oxygen Competencies' form (p.29-30) to be signed by | | |

| |assessor (school nurse) when the staff / carer has been successful in all areas of competency. | | |

| |This form is to be photocopied. One copy to be kept at the back of this manual as a record of | | |

| |training, the second copy will be given to the staff / carer for their own records. | | |

| |Spare copies are available at the back of the manual. | | |

| | | | |

|Insurance |Inform the school buildings insurance that oxygen equipment / cylinders are used on the school | | |

| |premises | | |

| | | | |

|Fire Department |Inform the local fire service that oxygen equipment is stored on the premises. | | |

| | | | |

|Storage of Cylinders |Please refer to the information on storage of cylinders (p17) | | |

| | | | |

|School Transport |Please refer to the information on transport (p.17) | | |

| |When a child arrives at school, during the day and before going home after school someone must | | |

| |be responsible for checking the oxygen cylinder ensuring that there is an adequate volume of | | |

| |oxygen in the cylinder for the school day and for the journey home. | | |

| |Insurance for the school transport must be informed. | | |

Child’s Personal Details

OXYGEN AND SUCTION CARE PLAN

Name: …………………………………………………….. DOB: ………………………………..

NHS number: ……………………………….

Specialist / Community Nurse: Contact details:

…………………………………………………………………………………………………………

………………………………………………………………………………………………………..

Date Plan commenced: ………………… Review Date: …………………….

| | |

|Oxygen flow required L/min |………………… L/min |

| | |

|Oxygen requirement |………………… hours / day |

|(eg. hrs/day, during daytime sleep only, nightime sleep, emergency use |………………………………………………… |

|only) |………………………………………………… |

| | |

|Recommended oxygen saturation parameters |…………………….% |

| | |

|Type of oxygen equipment provided in school |Oxygen concentrator Yes / No |

| | |

|Portable oxygen cylinder provided |Air Liquide……………………………………… |

| |Liquid oxygen…………………………………. |

| | |

|Duration of Portable Cylinder |.….………. hours at ….………L/min |

| | |

|Where spare cylinders are stored. |…………………………………………………… |

| | |

|Number of spare cylinders. |………………………………………………….. |

| | |

|Size of nasal cannula |Neonatal / Infant / Paediatric / Adult |

| |Duoderm + Mefix ……… |

|Cannula secured with |Mefix only …….. |

| |Tendergrips …….. |

| |No tapes …….. |

| |Other (please state) …………………… |

|Any known allergic reaction to tapes | |

|(please state) | |

| |…………………………………………………. |

|Times oxygen saturation to be monitored |………………………………………………… |

| | |

| | |

|Action to be taken if oxygen saturation falls below recommended oxygen | |

|saturation parameters | |

| | |

|Action to be taken if oxygen saturation does not improve | |

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|Suction requirement | |

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|Yankeur/ Nasal | |

|Regular during day / Nightime only / | |

|PRN during infections / emergency use only | |

|Indications for suction | |

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|Type and location of suction machine | |

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|Size and Type of Suction Catheter | |

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|Suction Pressure | |

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|Depth of Suction | |

Location of emergency kit: ………………………………………………………………………….

Any additional instructions:

Information source: Telephone message / letter / specialist nurse / parent

Signature: ……………………………………. Date: ……………………………….

Oxygen cylinder check form

Please check that the oxygen flow required by the child is set correctly and there is sufficient oxygen in the cylinder:

• at the start of a school / nursery day

• at lunchtime

• at the end of a school day

These are the minimum checks suggested however more checks can be performed through the day as required. We recommend that two people check the equipment and this can be one member of the staff and another staff member or parent.

Name: ………………………………………… DOB: ………………………………

O2 requirement: ……………………………………………………………………………..

|Date |Time |O2 flow |Cylinder contents: |

| | | |(full : 1/2 : ¼) |

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Education for Carers – Administration of Oxygen

Record of training

AIM

Carers will feel confident and have the knowledge to care for an oxygen dependent child safely. It is essential that all carers looking after children who are oxygen dependant possess an up to date resuscitation certificate.

OBJECTIVES

At the end of the training sessions, carers will be able to:

1. Have an understanding of basic anatomy.

2. Outline the reasons why a child may need supplemental oxygen.

3. Demonstrate a working knowledge of the equipment required.

4. Discuss the safety aspects of using oxygen.

5. Discuss procedure of ‘What to Do’ and ‘Who to Contact’, if there is an equipment failure / problem.

6. Outline methods of acquiring general advice and emergency help.

RESOURCES

• Identified instructor for training.

• ‘Oxygen Information Manual for use in School’s’

• Air Liquide ‘ Home Oxygen Service’ pack

• Equipment - nasal cannula / portable oxygen cylinder / concentrator (if applicable)

ACTION

1. Teaching session and demonstration.

2. Practical training.

3. Assessment and completion of competencies.

Education for Carers: Administration of Oxygen

(Information on p24-28 has been obtained from documentation produced by Ian Gould, Practice Development Facilitator, Claire House Hospice)

Actions, rationale and evidence base

1 Procedure for Administration of 0xygen

|Action |Rationale |Reference/evidence base |

|Environment: | |NHS Scotland (2002.) Home Oxygen Therapy for children being |

|The environment in which oxygen is to be administered is safe from |Oxygen strongly supports combustion. Oxygen increases the speed at |cared for in the community. Best Practice Statement. |

|accidental damage to supply and naked flames and other sources of |which things burn once a fire starts | |

|ignition | |Chandler (2001) Oxygen administration. Paediatric Nursing 13, |

| | |8, 37-42 |

|Oxygen is prescribed on the child / YP prescription chart |Oxygen is a drug that should be prescribed |British Medical Association (2001) British National Formulary. |

| | |Wallingford, The Pharmaceutical Press |

|Petroleum jelly or Vaseline should not be applied to child’s face, use| | |

|a water based gel if necessary. |Petroleum base gels can cause the skin to become red / inflamed and |Air Liquide technical guides |

| |sore | |

|Explain all procedures to child / YP | | |

|Appropriate source of oxygen supply is chosen |Oxygen is available from several sources. The source may change |Air Liquide technical guides for each portable cylinder |

| |depending on child’s activity /environment. | |

| | |C.H. Medical gas cylinder policy (2002) |

|Cylinder: | | |

|Appropriate size cylinder is used for the child that is safe for | | |

|activity/environment and contains sufficient oxygen for planned time | | |

|span. | | |

|Spare / replacement cylinders should be available | | |

| |Cylinders need to be secure particularly in transport and carried in | |

|Cylinders should not be able to move about freely. |appropriate bag. | |

|Store empty or surplus cylinders in agreed area outside. | | |

| | | |

|Keep free from oil and grease. |Oil and grease fuel combustion | |

| | | |

Actions, rationale and evidence base

2 Procedure for Oxygen Administration

|Action |Rationale |Reference/evidence base |

|Concentrator: |Concentrators turn atmospheric air into oxygen. They are for static |Air Liquide: |

|Requires mains electricity supply. delivers oxygen at litres (L)/ min.|delivery of oxygen. If the child/YP is to be moved consider necessity |’Your guide to using oxygen concentrator’ |

|Different concentrators available |of cylinder use for duration of move | |

|- Standard 1 – 5L /min (max use 4L/min) |[pic] | |

|Standard concentrator requires filter (single person use). Wash and |Oil and grease fuel combustion | |

|rinse filter in warm water after use. A mild detergent may be used if | | |

|rinsed thoroughly and ensure filter is completely dry before reuse. | | |

|Visionaire concentrator has internal filter and this does require any | | |

|cleaning. | | |

| | | |

|Keep the concentrator free from oil and grease | | |

|Liquid Oxygen: | |Air Liquide: |

|It is necessary to read the Air Products instruction booklet before |[pic] |‘Your guide to using liquid oxygen’ |

|use. Contact Air Products for further training. | | |

|Liquid Oxygen equipment comprises of 2 parts. The container “dewar” | | |

|and a refillable portable unit. The dewar contains liquid oxygen. It |[pic] | |

|should only be used to fill the portable unit. The portable unit is | | |

|designed to provide a source of oxygen and can deliver up to 2 | | |

|litres/min. | | |

|To fill the portable unit from the dewar please read instruction | | |

|booklet which also provides calculations for how long the portable | | |

|unit will last when full. | | |

|To use the portable unit: push oxygen tubing onto oxygen outlet | | |

|connector, place cannula/mask on child / YP. Turn the flow rate on top| | |

|of the portable unit to the prescribed rate (visible in window). | | |

|To check the level of oxygen in the portable unit, lift the unit by | | |

|the contents gauge. Allow the unit to stabilise before reading the | | |

|approximate contents. | | |

|To turn the unit off, turn flow rate control to (O). | | |

|Always use the unit in an upright position. If laid on its side it | | |

|will very rapidly vent and make a loud clatter | | |

|Never cover portable unit. | | |

Actions, rationale and evidence base

3 Procedure for Oxygen Administration

|Action |Rationale |Reference/evidence base |

|Nasal Cannulae: | |Chandler (2001) Oxygen administration. Paediatric Nursing 13, 8, |

|Ensure appropriate size chosen. |The child’s / YP skin area will be left undisturbed if re-adjustment is|37-42 |

|Attach the oxygen tubing to gas source. |necessary. | |

|Set oxygen to the desired flow rate and verify flow. |Only low flows can be delivered comfortably |Mallett and Bailey (1996) The Royal Marsden NHS Trust Manuel of |

|No more than 2 litres/min should be delivered via nasal cannulae |[pic] |Clinical Nursing Procedures (4th edition) London, Blackwell |

|If needed, secure to child’s / YP cheeks – apply duoderm to skin and | |Science. cited in Chandler (2001) Oxygen administration. |

|tape tubing to duoderm Ensure the prongs are in each nostril. | |Paediatric Nursing 13, 8, 37-42 |

|Tracheostomy: | | |

|Use either the thermovent (swedish nose) and green portex tubing or |Choice the most appropriate and comfortable connection. The Trachphone | |

|the Trachphone tracheostomy connection. |does not need to be disconnected for suction | |

|Attach oxygen to gas source. | | |

|Set oxygen to the desired flow and verify flow | | |

|No more than 2 litres/min should be delivered | | |

| | | |

| | | |

|Tracheostomy Mask: | | |

|Place mask over tracheostomy tube and place straps |Tracheostomy mask is generally used if a child requires> 2L/O2/min | |

|Attach oxygen to gas source. | | |

|Set oxygen to the desired flow and verify flow | | |

|Delivery via non-rebreathing mask: | |Chandler (2001) Oxygen administration. Paediatric Nursing 13, 8, |

|Ensure appropriate size chosen |The non-rebreathing mask allows only oxygen to be inhaled. They are |37-42 |

|Attach the oxygen tubing to gas source, |generally only used in an emergency situation. | |

|Set oxygen to the desired flow and verify flow |Valves must be in correct working order to ensure expired CO2 is not | |

|Verify proper function of valves: The valve between the mask and the |inhaled |Hudson RCI. (2004) |

|reservoir should rise on inspiration and lower on exhalation. | | |

|The valve on external mask surface should open during exhalation. | | |

|Mould the metal strip on the | | |

|mask to fit the child’s face. | | |

Actions, rationale and evidence base

1 Procedure for Oxygen Saturation Monitoring

|Action |Rationale |Reference/evidence base |

|Oxygen Saturation Monitoring: | |Place (2000) cited in Chandler T (2000) Oxygen saturation |

|The child / YP condition may require oxygen saturation monitoring with|A pulse oximeter measures the arterial blood oxygen saturation. When |monitoring. Paediatric Nursing. 12, 8. 37-42 |

|a pulse oximeter as either routine or for spot cheeks. |haemoglobin (red blood cells) is well saturated with oxygen it is red | |

| |and has the capacity to absorb more light from the red infrared probe |Hackett (1996) cited in Chandler T (2000) Oxygen saturation |

| |on a saturation monitor. When haemoglobin has a lower oxygen |monitoring. Paediatric Nursing. 12, 8. 37-42 |

| |concentration, the blood changes to a bluer colour and the amount of | |

| |light absorbed from the infrared light that passes through the skin is | Products > Pulse Oximetry |

| |reduced. | |

| | | |

|Use either the child’s own oximeter at planned times of the day or |There are different types of oxygen saturation monitor; there are hand | |

|spot check as required. |held ones, which are usually used for “one off” or “spot check” | |

|Familiarise yourself with the machine |reading. | |

| |Larger monitors are used for longer term monitoring | |

| |[pic] | |

|Choice of probe site: | |Chandler T (2000) Oxygen saturation monitoring. Paediatric |

|There are many types of probes that can be used and sites to place |The finger or big toe can be used for spot checks. |Nursing. 12, 8. 37-42 |

|them. |Suggested places of probe site for longer monitoring | |

| |[pic][pic][pic] |Whaley and Wong (1999) cited Chandler T (2000) Oxygen saturation |

| | |monitoring. Paediatric Nursing. 12, 8. 37-42 |

| |This may give rise to inaccurate readings | |

| | |St John Ambulance (1998) cited in Chandler T (2000) Oxygen |

| | |saturation monitoring. Paediatric Nursing. 12, 8. 37-42 |

| |The infrared light shines down through the skin, and on the opposite | |

| |side the reading is picked up. | |

|Ensure the site is clean and there is no nail varnish or dirty skin / | |Clinicians Guide to Nellcor Sensors |

|nails. | | |

| | | |

|Ensure the probe is fastened the right way up | | |

Actions, rationale and evidence base

2 Procedure for Oxygen Saturation Monitoring

|Action |Rationale |Reference/evidence base |

|Changing of probe sites: | |MDA (1988) Safety Information Bulletin (SIB 88 NO 46), Pulse |

|The probe site should be inspected and probe changed according to |It is possible to cause damage to the skin when using an oxygen |Oximeters: Potential dangers During Use |

|manufacturers guidelines |saturation probe particularly when the skin is sensitive. There is a | |

| |risk of the probes being secured too tightly or being left on too long | |

|Check site every 2-4 hours | |Clinicians Guide to Nellcor Sensors |

|Nellcor Oximax probes - MAX-N and MAX-I should be inspected | | |

|routinely and changed every 8 hours | | |

| | | |

|Oximax reusable sensors (eg. Finger clip sensor) should be inspected | | |

|routinely and changed within 4 hours | | |

|Alarm Limits | |Ashurst (1995) cited in Chandler T (2000) Oxygen saturation |

|Set the alarm limits according to the child’s care plan (oxygen |Each child will have agreed oxygen saturation and pulse parameters |monitoring. Paediatric Nursing. 12, 8. 37-42 |

|saturation and pulse). |according to their condition. A child with a chronic chest condition | |

| |and / or cardiac condition is unlikely to saturate at a “normal” level |Place (1998) cited in Chandler T (2000) Oxygen saturation |

| |therefore different ranges will be determined. |monitoring. Paediatric Nursing. 12, 8. 37-42 |

| |Often the probe may become detached causing the monitor to alarm. It is| |

|Be aware of complacency due to nuisance alarms |important not to assume this has happened upon hearing the alarm. | |

| |Saturation monitors should be used in conjunction with nursing skills | |

| |and should not replace them. | |

|Upon hearing the alarm pay immediate attention to the child / YP not |Alarm settings are matched to the individual child’s needs. | |

|the monitor. | | |

|Do not change alarm settings to remedy nuisance alarms. | | |

|Starting to monitor: | |Peck (1999) cited in Chandler T (2000) Oxygen saturation |

|Ensure there is an adequate trace on the machine. |This determines if reading is to be considered reliable. |monitoring. Paediatric Nursing. 12, 8. 37-42 |

| |The signal may be in simple bar form and indicate signal strength. This| |

| |needs to be at its highest point. | |

| |Or it could be in waveform (plethysmograph) as below | |

| |[pic] | |

| | | |

| | | |

| | | |

| | | |

| | | |

|Continue to monitor the child’s / YP other vital signs (colour, | | |

|respiratory rate etc) | | |

Administration of Oxygen Competencies

Name of Carer……………………………………………… Position …………………………………………………….

Name of Assessor …………………………………………. Position ……………………………………………………..

|Area of competency |Assessor’s to sign on completion |

|Knowledge of children’s different respiratory problems and the need for supplemental oxygen | |

|Nasal Cannulae | |

|Demonstrates that they can correctly change and secure the nasal cannulae | |

|Appropriate size selected for the child | |

|Correct use of the different tapes | |

|Tracheostomy Connections (if applicable) | |

|Carer has successfully completed a tracheostomy training programme | |

|Aware of the different methods of administrating oxygen via a tracheostomy | |

|Portable oxygen cylinders | |

|Demonstrates correct use of the portable oxygen cylinder | |

|Can set the oxygen flow (L/min) at the child’s requirement | |

|Can correctly alter the flow if required | |

|Can calculate how long the cylinder will last at different flows and where to obtain this information | |

|Understands that someone is allocated responsibility to ensure that the cylinder flow rate and contents are checked at the beginning | |

|of the school day and frequency throughout the day | |

|Understands the importance of checking portable oxygen cylinder contents at the end of the day for transport home | |

|Concentrator | |

|Demonstrates correct use of using an oxygen concentrator | |

|Can set the oxygen flow (L/min) at the child’s requirement | |

|Can correctly alter the flow if required | |

|Can correctly change and clean the filter (as instructed by Air Liquide) | |

|Liquid Oxygen | |

|Demonstrates correct use of using liquid oxygen | |

|Can set the oxygen flow (L/min) at the child’s requirement | |

|Can correctly alter the flow if required | |

|Can discuss the specific safety aspects of using liquid oxygen | |

|Oxygen Safety | |

|Aware of the oxygen safety advice and precautions | |

|Discuss the general safety advice and precautions needed when using oxygen | |

|Discuss and demonstrate the securing of oxygen cylinders during transport | |

|Oxygen saturation monitoring | |

|Demonstrates correct use of oxygen saturation monitoring equipment | |

|Knowledge of ‘normal saturations’ | |

|Aware that some children may not have normal saturations eg. some cardiac pts | |

|Knowledge that oxygen needs to be prescribed for each individual child with information of child’s specific saturations levels eg. | |

|normal oxygen requirement …..L/min, oxygen to maintain SaO2 93-98% | |

|Demonstrates use of equipment | |

|- uses a saturation monitor correctly and aware of different monitors | |

|- can correctly set appropriate alarm limits | |

|- correctly secures the probe and can discuss different probes and | |

|probe sites that can be used for monitoring | |

|Can discuss the importance of checking and changing the probe site | |

|Emergency / Equipment failure | |

|Knowledge of what to do and who to contact in case of equipment failure or emergency | |

|Demonstrates a knowledge of where emergency / spare oxygen cylinders are stored | |

|Discuss the procedure required for faulty equipment | |

|Discuss the correct procedure in the case of a fire | |

Date of assessment …………………………………………

Signature of Carer .………………………………………… Update date (yearly) …………………………..

Useful Addresses and Contact Numbers

OXYGEN NURSE PRACTITIONER

Carol Lawrence

Alder Hey Children’s Hospital NHS Foundation Trust

Eaton Road

Liverpool

L12 2AP

Tel: 0151 252 5625

Air Liquide Home Care

Alpha House

Wassage Way

Hampton Lovett

Droitwich

WR9 0NX

Tel: 0808 143 9992

BRITISH LUNG FOUNDATION (BLF)

73-75 Goswell Road

London

EC1V 7ER

Tel: 020 7688 5555

The British Lung Foundation offers advice and support for people with lung conditions The Breathe Easy Club produce a quarterly magazine with practical tips and advise about coping with lung disease.

FAMILY FUND

PO BOX 50

York

YO1 9ZX

Tel: 01904 621115

The Family Fund Trust is funded by the Government to help families with severely disabled children. There are financial guidelines, which are concerned with the child’s disability, the family’s financial circumstances and the kind of help given. Please contact the Family Fund for further info.

Article / Reference List

Balfour-Lynn IM, Primhak RA, Shaw BNJ. Home Oxygen for children: who, how and when? Thorax. 2005; 60, 76-81

Boosfield B, O’Toole M. Technology-dependent Children: Transition from hospital to home. Paediatric Nursing; 2000; 12, (6), 20-22

Dunbar H, Kotecha S. Domiciliary Oxygen for Infants with Chronic Lung Disease of Prematurity. Care of the Critically Ill; 2000; 16, (3), 90-93

Embon C. Discharge Planning for Infants with Bronchopulmonary Dysplasia. Journal of Perinatal Neonatal Nursing; 1991; 5(1), 54-63

Glendinning C, Kirk S. High –tech care: highly skilled parents. Paediatric Nursing; 2000; 12, (6), 25-27.

Greenough A. Respiratory sequelae of neonatal disease. The National Asthma Campaign’s Asthma Journal; 1997; 2, (3), 102 – 105

Harrison G. (2002) Oxygen Therapy at Home. Nurse to Nurse; 2, (5), 28 – 32

Kotecha S, Allen J. Oxygen therapy for infants with chronic lung disease. Archives of Disease in Childhood Neonatal Ed. 2002; 87, F11-14

Manns S. Life after SCBU. Journal of Neonatal Nursing; 2000; 6, (6), 193-196

Ng A, Subhedar N, Primhak R, Shaw NJ. Arterial oxygen saturation profiles in healthy preterm infants. Archives of Disease in Childhood Fetal Neonatal Ed; 1998; 79, F64 – F66

Poets CF. Do Infants Need Additional Inspired Oxygen? A Review of the Current Literature. Pediatric Pulmonology; 1998; 26, 424 - 428

Royal College of Physicians. (1999) Domicillary oxygen therapy services: clinical guidelines and advise for prescribers. A report of the Royal College of Physicians: commissioned by the Department of Health

Sleath K. Breath of Life. Nursing Times. 1989; 85, (44), 90-93

Solis A, Harrison G, Shaw NJ (2002) Assessing oxygen requirement after discharge in chronic lung disease: A survey of current practise. European Journal of Paediatrics. 2002; 161, 428-430

-----------------------

AIR LIQUIDE

Freephone Homecare Helpline 0808 143 9992

Office Hours: Monday– Friday 08.30 am – 5.30 pm

1. What to do if the Child has Breathing Problems

Is the child?

• chesty

• wheezy

• coughing more than usual

• has a temperature

Does your child have any of the following?

• going ‘blue’ – do they look blue around their lips, nails or ear lobes

• short of breath or breathing a lot quicker than normal

• looking unusually pale

• ‘tugging’ when breathing - pulling in the muscles around their chest or neck

• sweaty and clammy

• a fast pounding pulse rate

• reduced consciousness or unusually agitated

• (in older children) confused and / or complaining of dizziness or headaches

YES

Advised that the child may need a GP appointment for review

NO

YES

Stay calm and reassure your child

Check the child’s airway

• Make sure your child’s nose and mouth or tracheostomy is not obstructed with mucus

Is the oxygen equipment working correctly?

Check:

• is the oxygen supply working eg. Is there sufficient oxygen left in the cylinder

• is the oxygen tubing correctly connected

• is the oxygen flow set at the correct flow rate

• is the tubing is mucus free and not kinked

•

If there are any problems with the oxygen equipment then connect the back up supply and contact the child’s parents.

•

NO

Check your child’s breathing returns to normal

Is there still a problem with their breathing?

Emergency procedure

YES

Call 999 for immediate help and advice

Increase the oxygen flow to your child, as per care plan

Is the child breathing?

Stay with your child and await the help of the emergency services

YES

NO

Start resuscitation procedure whilst waiting for the emergency services to arrive

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