Neonatal
Policy & Procedures
Oxygen Delivery
Approved by:
Gail Cameron
Senior Director Operations, Maternal, Neonatal & Child Health Programs
Manual
Policy Group: Respiratory
Date Approved
October 2015
Date Effective
October 2015
Next Review
October 2018
Dr. Paul Byrne
Medical Director, Neonatology
Dr. Sharif Shaik
Medical Director, Neonatology
Purpose
To provide guidelines for delivery of supplemental oxygen to neonates in
the Neonatal Nursery.
Policy
Statement
Supplemental oxygen is a drug with life sustaining potential and potential
toxicities. Many newborn diseases create situations where supplemental
oxygen is required; however, newborns have reduced anti-oxidant defences
and underdeveloped central nervous, respiratory and haematological
systems that are prone to oxidative stress. Prolonged low oxygen
saturations are associated with poorer survival, more complicated clinical
courses and poorer neurodevelopmental outcomes. Side effects of oxygen
administration seem to be related to high oxygen levels, rapid & wide
changes in oxygenation, sustained hyperoxemia, and episodes of
hypoxemia. This situation requires careful attention to oxygen
administration to maintain a balance between sufficient oxygen levels and
risk of deleterious side effects.
Applicability
All Covenant Health employees in the Neonatal Nursery.
Principles
•
•
•
•
•
•
•
•
•
Unless given in an emergency, oxygen administration requires an
order.
Use of oxygen in the delivery room follows guidelines established by
Canadian Neonatal Resuscitation Steering Committee.
Except during resuscitation, all administered oxygen is humidified
Administer oxygen via a heated humidified system unless given by
low-flow cannula, bag or T-piece resuscitator.
Unless given by low flow cannula, administered oxygen
concentration is titrated with a blended source.
Blender accuracy is verified utilizing an oxygen analyzer.
All infants receiving oxygen are monitored by pulse oximetry
according to Non-Invasive Monitoring Policy
Pulse oximetry limits are ordered by physician or NNP on the patient
care orders with a specified COD profile or ordered upper and lower
limits.
Adjustment of oxygen for NICU patients will follow the attached COD
algorithm.
Date Approved
October 2015
Oxygen Delivery
Policy No.
Premie
NO device
Premie on
resp device
Term
NO device
Term on resp
device
Defining
Characteristics
≤ 36+6
≤ 36+6
≥ 37wk
Not on O2
≥ 37wk
on O2
SpO2 Alarm Limit
88-100
88-93
92-100
High & Low SpO2
Delay Time
30 Sec
30 Sec
82
0 Sec
Page 3 of 5
Extended
Cardiac
Car Seat
Labile SpO2
(ie. PDA,CLD)
Individualized
Car Seat
92-97
88-95
75-85 or
as ordered
88-100
30 Sec
30 Sec
30 Sec
30 Sec
10 sec
* low SpO2
only
82
82
82
82
75 or
as ordered
0 Sec
0 Sec
0 Sec
10 Sec
0 Sec
Red alarm only
for SpO2 <88.
This is a
significant
event
Monitor Setting
Minimum SpO2
Minimum SpO2
Delay time
H: ___
L: ___
Please use a “bubble” (along with a fish) for all patients that require individualized SpO2 settings as determined
by the multidisciplinary team during rounds.
Averaging time for All Profiles = 10 seconds
Definitions:
SpO2 Alarm Limit
High & Low SpO2 Delay Time
Minimum SpO2 Delay Time
Averaging Time
Above or below this limit alarm will sound after delay time is reached.
30 seconds
SpO2 must be above or below the limit for 30 seconds
0 seconds
When SpO2 drops below this level a red alarm occurs immediately. For Extended and Car Seat profile only – 10 second delay.
10 seconds
SpO2 is averaged over 10 seconds and then displayed on the monitor. The display is updated with every beat.
Oxygen Delivery
Date Approved
October 2015
Policy No.
Page 4 of 5
Related
Documents
Non-invasive monitoring.
Neonatal Resuscitation in the Delivery Room
Assisted Ventilation Care of Infant
References
Adapted with permission from Stollery Children’s Policy and Procedure Manual:
http://insite.albertahealthservices.ca/assets/policy/clp-capital-nicu-pp-respiratory-oxygenadmin-pol.pdf Oxygen Administration July 2012
Revisions
October 2012
October 2015
Signing
Original Signed
December 2015
__ _______________________
_____________
DATE
GAIL CAMERON
SENIOR DIRECTOR OPERATIONS
MATERNAL, NEONATAL & CHILD HEALTH PROGRAMS
COVENANT HEALTH
GREY NUNS & MISERCORDIA HOSPITALS
Original Signed
December 2015
_________________________
DR. PAUL BYRNE
DATE
MEDICAL DIRECTOR
NEONATAL PROGRAM
COVENANT HEALTH
GREY NUNS HOSPITAL
Original Signed
___ ______________________
DR. SHARIF SHAIK
MEDICAL DIRECTOR
NEONATAL PROGRAM
COVENANT HEALTH
MISERICORDIA HOSPITAL
December 2015
________________
DATE