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
5 – 13
2. Oxygen Equipment
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
2
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
3
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
4
Principle Paediatric Conditions requiring Long Term Oxygen Therapy
(LTOT)
Chronic Neonatal lung Disease (Bronchopulmonary Dysplasia)
Other Neonatal Condition (eg. Pulmonary hypoplasia)
Congenital Heart Disease with pulmonary hypertension
Pulmonary Hypertension secondary to pulmonary disease
Interstitial Lung Disease
Obliterative Bronchiolitis
End Stage Cystic Fibrosis and other causes of severe bronchiectasis
Obstructive Sleep apnoea syndrome and other sleep related disorders
Neuromuscular conditions requiring non invasive ventilation
Disorders of the chest wall (eg. Thoracic dystrophy, severe kyphoscoliosis)
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.
5
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)
AIR LIQUIDE
Freephone Homecare Helpline
0808 143 9992
Office Hours: Monday– Friday 08.30 am – 5.30 pm
Oxygen Concentrator
 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)
Figure 2. Air Liquide oxygen concentrator
7
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
8
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 wellventilated 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.
9
Static Cylinders
10
Portable Cylinders
11
Mirco Flow / Low Flow regulators
12
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.
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’
13
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)
(or Blenderm -clear tape)
14
Figure 8. Tendergrip stickers
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
www.atosmedical.com
15
Oxygen Safety
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 ECIGARETTES 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).
16
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.
17
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.
18
Problems
1. What to do if the Child has Breathing Problems
Is the child?




Does your child have any of the following?
chesty
wheezy
coughing more than usual
has a temperature




YES




Advised that the child may need a
GP appointment for review
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
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
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 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
Is there still a problem with their
breathing?
YES
Emergency procedure
Call 999 for immediate help and advice
Increase the oxygen flow to your child, as per care plan
Stay with your child and await the
help of the emergency services
YES
Is the child breathing?
NO
Start resuscitation procedure whilst waiting
for the emergency services to arrive
RESUSITATION TRAINING IS REQUIRED
19
Check list for schools
Action
Information
about the child



Oxygen
Equipment /
Safety Training







Date
Complete the 'Child Personal Details' form (p.22-23).
Ensure a copy is kept with the child's school medical
records
Spare copies are available at the back of the manual.
Identify key trainer / assessor
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.

20
Sig
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
(eg. hrs/day, during daytime sleep only,
nightime sleep, emergency use only)
………………… hours / day
…………………………………………………
…………………………………………………
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
Cannula secured with
Duoderm + Mefix ………
Mefix only
……..
Tendergrips
……..
No tapes
……..
Other (please state) ……………………
Any known allergic reaction to tapes
(please state)
Times oxygen saturation to be monitored
………………………………………………….
…………………………………………………
21
Action to be taken if oxygen saturation falls
below recommended oxygen saturation
parameters
Action to be taken if oxygen saturation does
not improve
Suction requirement
Yankeur/ Nasal
Regular during day / Nightime only /
PRN during infections / emergency use only
Indications for suction
Type and location of suction machine
Size and Type of Suction Catheter
Suction Pressure
Depth of Suction
Location of emergency kit: ………………………………………………………………………….
Any additional instructions:
Information source: Telephone message / letter / specialist nurse / parent
Signature: …………………………………….
Date: ……………………………….
22
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)
23
School /
Nursery
Staff sig
Staff /
Parents
sig
Comments
Staff requiring Oxygen Equipment and Oxygen Safety Training
List the names of staff that require oxygen training.
Complete other information when the assessment has been successful.
Name
Date
assessment
completed
24
Assessor
Update
date
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.
25
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
Environment:
The environment in which oxygen is to be
administered is safe from accidental damage to
supply and naked flames and other sources of
ignition
Rationale
Oxygen strongly supports combustion. Oxygen
increases the speed at which things burn once a fire
starts
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
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 sore
Explain all procedures to child / YP
Appropriate source of oxygen supply is chosen
Reference/evidence base
NHS Scotland (2002.) Home Oxygen Therapy
for children being cared for in the community.
Best Practice Statement.
Oxygen is available from several sources. The
source may change depending on child’s activity
/environment.
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
British Medical Association (2001) British
National Formulary. Wallingford, The
Pharmaceutical Press
Air Liquide technical guides
Air Liquide technical guides for each portable
cylinder
C.H. Medical gas cylinder policy (2002)
Cylinders should not be able to move about freely.
Store empty or surplus cylinders in agreed area
outside.
Cylinders need to be secure particularly in transport
and carried in appropriate bag.
Keep free from oil and grease.
Oil and grease fuel combustion
26
Actions, rationale and evidence base
2
Action
Procedure for Oxygen Administration
Rationale
Concentrator:
Requires mains electricity supply. delivers oxygen
at litres (L)/ min.
Different concentrators available
- Standard 1 – 5L /min (max use 4L/min)
Standard concentrator requires filter (single
person use). Wash and 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.
Concentrators turn atmospheric air into oxygen.
They are for static delivery of oxygen. If the child/YP
is to be moved consider necessity of cylinder use
for duration of move
Keep the concentrator free from oil and grease
Liquid Oxygen:
It is necessary to read the Air Products instruction
booklet before 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 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.
Oil and grease fuel combustion
Reference/evidence base
Air Liquide:
’Your guide to using oxygen concentrator’
Air Liquide:
‘Your guide to using liquid oxygen’
27
Actions, rationale and evidence base
3
Action
Nasal Cannulae:
Ensure appropriate size chosen.
Attach the oxygen tubing to gas source.
Set oxygen to the desired flow rate and verify flow.
No more than 2 litres/min should be delivered via
nasal cannulae
If needed, secure to child’s / YP cheeks – apply
duoderm to skin and tape tubing to duoderm
Ensure the prongs are in each nostril.
Tracheostomy:
Use either the thermovent (swedish nose) and
green portex tubing or the Trachphone
tracheostomy connection.
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
Attach oxygen to gas source.
Set oxygen to the desired flow and verify flow
Delivery via non-rebreathing mask:
Ensure appropriate size chosen
Attach the oxygen tubing to gas source,
Set oxygen to the desired flow and verify flow
Verify proper function of valves: The valve between
the mask and the 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.
Procedure for Oxygen Administration
Rationale
The child’s / YP skin area will be left undisturbed if
re-adjustment is necessary.
Only low flows can be delivered comfortably
Reference/evidence base
Chandler (2001) Oxygen administration.
Paediatric Nursing 13, 8, 37-42
Mallett and Bailey (1996) The Royal Marsden
NHS Trust Manuel of Clinical Nursing
Procedures (4th edition) London, Blackwell
Science. cited in Chandler (2001) Oxygen
administration. Paediatric Nursing 13, 8, 37-42
Choice the most appropriate and comfortable
connection. The Trachphone does not need to be
disconnected for suction
Tracheostomy mask is
generally used if a child
requires> 2L/O2/min
The non-rebreathing mask allows only oxygen to be
inhaled. They are generally only used in an
emergency situation.
Valves must be in correct
working order to ensure expired
CO2 is not inhaled
28
Chandler (2001) Oxygen administration.
Paediatric Nursing 13, 8, 37-42
Hudson RCI. (2004) www.hudsonrci.com
Actions, rationale and evidence base
1
Action
Oxygen Saturation Monitoring:
The child / YP condition may require oxygen
saturation monitoring with a pulse oximeter as
either routine or for spot cheeks.
Use either the child’s own oximeter at planned
times of the day or spot check as required.
Familiarise yourself with the machine
Choice of probe site:
There are many types of probes that can be used
and sites to place them.
Procedure for Oxygen Saturation Monitoring
Rationale
A pulse oximeter measures the arterial blood
oxygen saturation. When 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 on a saturation monitor. When
haemoglobin has a lower oxygen concentration, the
blood changes to a bluer colour and the amount of
light absorbed from the infrared light that passes
through the skin is reduced.
Reference/evidence base
Place (2000) cited in Chandler T (2000) Oxygen
saturation monitoring. Paediatric Nursing. 12, 8.
37-42
Hackett (1996) cited in Chandler T (2000)
Oxygen saturation monitoring. Paediatric
Nursing. 12, 8. 37-42
www.nellcor.com Products > Pulse Oximetry
There are different types of oxygen saturation
monitor; there are hand held ones, which are
usually used for “one off” or “spot check” reading.
Larger monitors are used for longer term monitoring
The finger or big toe can be used for spot checks.
Suggested places of probe site for longer monitoring
Chandler T (2000) Oxygen saturation
monitoring. Paediatric Nursing. 12, 8. 37-42
Whaley and Wong (1999) cited Chandler T
(2000) Oxygen saturation monitoring. Paediatric
Nursing. 12, 8. 37-42
Ensure the site is clean and there is no nail varnish
or dirty skin / nails.
This may give rise to inaccurate readings
Ensure the probe is fastened the right way up
The infrared light shines down through the skin, and
on the opposite side the reading is picked up.
29
St John Ambulance (1998) cited in Chandler T
(2000) Oxygen saturation monitoring. Paediatric
Nursing. 12, 8. 37-42
www.nellcor.com
Clinicians Guide to Nellcor Sensors
Actions, rationale and evidence base
2
Action
Changing of probe sites:
The probe site should be inspected and probe
changed according to manufacturers guidelines
Check site every 2-4 hours
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
Set the alarm limits according to the child’s care
plan (oxygen saturation and pulse).
Be aware of complacency due to nuisance alarms
Upon hearing the alarm pay immediate attention to
the child / YP not the monitor.
Do not change alarm settings to remedy nuisance
alarms.
Starting to monitor:
Ensure there is an adequate trace on the machine.
Procedure for Oxygen Saturation Monitoring
Rationale
It is possible to cause damage to the skin when
using an oxygen 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
Each child will have agreed oxygen saturation and
pulse parameters according to their condition. A
child with a chronic chest condition and / or cardiac
condition is unlikely to saturate at a “normal” level
therefore different ranges will be determined.
Often the probe may become detached causing the
monitor to alarm. It is 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.
Alarm settings are matched to the individual child’s
needs.
This determines if reading is to be considered
reliable.
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
Continue to monitor the child’s / YP other vital
signs (colour, respiratory rate etc)
30
Reference/evidence base
MDA (1988) Safety Information Bulletin (SIB 88
NO 46), Pulse Oximeters: Potential dangers
During Use
www.nellcor.com
Clinicians Guide to Nellcor Sensors
Ashurst (1995) cited in Chandler T (2000)
Oxygen saturation monitoring. Paediatric
Nursing. 12, 8. 37-42
Place (1998) cited in Chandler T (2000) Oxygen
saturation monitoring. Paediatric Nursing. 12, 8.
37-42
Peck (1999) cited in Chandler T (2000) Oxygen
saturation monitoring. Paediatric Nursing. 12, 8.
37-42
Administration of Oxygen Competencies
Name of Carer……………………………………………… Position …………………………………………………….
Name of Assessor …………………………………………. Position ……………………………………………………..
Assessor’s
completion
Area of competency
1. Knowledge of children’s different respiratory problems and the need for
supplemental oxygen
2. 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
3. Tracheostomy Connections (if applicable)
 Carer has successfully completed a tracheostomy training programme
 Aware of the different methods of administrating oxygen via a tracheostomy
4. 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
5. 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)
31
to
sign
on
6. 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
7. 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
8. 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
9. 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
…………………………………………
.…………………………………………
32
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.
33
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
34