NW Newborn Clinical Guideline - Oxygen Therapy - Low Flow For Infants >36 weeks gestation

Compiled and Reviewed by Nicola Svirskis - NE

May
2009

Low Flow Oxygen/Air administration is used for infants requiring some respiratory support but not CPAP

Flows
- 300 ml/min - 1000 ml/min require humidifying
- below 300 ml/min are not humidified
When utilising humidified flows watch for rainout in the circuit and try to ensure that it is cleared back into the humidifier regularly to avoid lavage (see humidified high flow for set up information)
Low flow oxygen is measured in ml/min not litres
- read from the centre of the ball.
- take careful note of ml/min being delivered. There are different flow meters in use. Check ml/min with another staff member.
When an infant is stable on Low Flow respiratory support it may be moved into a cot and attempts at feeding can be instituted.

Steps	Action
1	Any increase in O₂ during feeds should be documented.
2	Choose appropriate prong size (small or medium). Prongs should fit snugly and be taped to face appropriately using thin Duoderm as a base and Hyperfix to tape.
3	Check that nasal prongs are clear, frequently; changing once a week or more frequently if required.

Low flow can be separated into 3 categories:

Combination of Low Flow Oxygen and Low Flow Air

This may be used on consultant's orders to support a baby when CPAP is discontinued but the infant continues to have a minimal oxygen requirement.

If this mode of respiratory support is utilised for infants <36weeks gestation an oxygen analyser must be present in the circuitry (i.e. will need to have a flow of >300ml/min running via the humidifier).

The combination may be:

Steps	Action
1	Use a Y connector to join the low flow O₂ and low flow air.
2	Use a low flow air meter to deliver 250ml of air.
3	Use low flow oxygen meter to deliver a maximum of 125ml to maintain an appropriate SaO₂as per Standing Orders

Used for babies requiring long term oxygen therapy.
Not administered to babies under 36 weeks as it is difficult to be certain of the FiO2 actually delivered and difficult to maintain the Sp02 saturations in the target range of 88 - 92%.
Not generally used for babies requiring a flow of more than 300ml/min.
Oxygen is administered as per standing orders.
Parents of infants who are likely to be on Low Flow Oxygen at home can begin to learn to manage the Low Flow tubing and learn about signs that their infant is not coping (see home oxygen guideline)

This may be used for individual babies on Consultant order, as a transition from CPAP to room air.

Steps	Action
1	Use a low flow air meter to delivery 300ml of air.
2	The flow may be weaned to 250ml, no less, before trialling off (following discussion on medical round).

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