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High Flow Nasal Oxygen (HFNO)

Amanda Allan is one of our charge nurses in the Intensive Care Unit. Here she demonstrates how the HFNO machine is set up, and how it is attac
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MALCOLM SIM: In this video, we’ll demonstrate how to set up a high-flow nasal-oxygen device. This is a humidifier, an integrated flow generator, which can deliver oxygen concentrations from 21% to 95% at flows between 2 and 60 litres per minute. The water chamber enables breathing gases to be warmed and humidified at optimal body temperature of 37 degrees, while the breathing tube incorporates a heated wire to minimise condensation. In respiratory failure, a patient’s peak inspiratory flow rate can be as high as 120 litres per minute. Low-flow devices such as a Hudson mask, are insufficient to match this flow rate, resulting in treatment of room air. This dilutes the effective of oxygen concentration which reaches the lung.
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So high-flow nasal oxygen better matches a patient’s peak inspiratory flow rate and reduces the work of breathing.
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AMANDA ALLAN: First of all, we’re going to connect the wall-mounted oxygen supply. Then we’re going to take the electricity supply and connect that and plug in the high flow. Next, we’ll remove the red decontamination tubing because it goes through a process of decontamination. I’m going to switch on the high flow. It will go through a self check and I’ll also get the traffic lights that will show and indicate that it’s ready for use. While it’s doing that, I’m going to take the water chamber and I’ll connect the adapter to the top, press down on quite firmly so it is well connected.
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Then I’m going to depress the finger here and slide it in, all lined up. Next I’ll take a bag of sterile water for inhalation. I’m going to spike the bag here with the tubing. Make sure it’s tight– the connection. And then I’m going to hang the bag here, and just look to ensure that it’s starting to fill with water. And it’s going to fill to the water level here. Then I’m going to take the heated-wire oxygen tubing. And it connects on the top here. There’s two little prongs that you’ll line up with. You’ll pull back on the blue part. Press down once you’re lined up, quite firmly. And then push down the blue section of the tubing.
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You can hang this up here in the little holder to keep it clean. While you do the last part, which is take the bag of green oxygen tubing. And you want to connect that one to your oxygen flow metre here at the top. And then it connects here on the bottom of the high-flow unit on the little nipple. And the next thing you want to do is just set on the actual settings. You can use the flow meter here to set your oxygen. And you’ll get a display here. So say we’ll put it on at 50% oxygen, so we turn this up. And the other part to adjust is just the temperature.
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And you want to set it to 37 degrees body temperature.
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So we’re just going to change this oxygen over. We’re going to take this mask off, like we spoke about. And this is a special oxygen that’s going to help you with your breathing. So this is going to inside your nose. How does that feel?
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SUBJECT: It’s fine.
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AMANDA ALLAN: Is that alright?
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SUBJECT: Mm-hmm.
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AMANDA ALLAN: May get that funny sensation at first. And I’m going to clip this onto your gown so the oxygen tubing doesn’t pull on anything. Is that OK for you?
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SUBJECT: Mm-hmm.

Dr Malcolm Sim is one of the programme directors for the MSc in Critical Care run in conjunction with the University of Glasgow. He is also one of the lead educators for this course. In this video he explains what high flow nasal oxygen (HFNO) is, how it works, and why it is superior to other forms of oxygen delivery.

He specifically explains the importance of the oxygen being humidified, and how HFNO better matches the patients’ oxygen requirements making it easier for them to maintain adequate oxygenation.

Amanda Allan is another one of our charge nurses in the Intensive Care Unit. Here she demonstrates how the HFNO machine is set up, and how it is attached to the patient.

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