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Description
RESEARCH
Purpose:
Oxygen delivery via nasal cannula is a standard therapy in hospitalized pediatric patients; however, it can have adverse effects in certain populations, such as infants with cardiac shunting physiology1,2. An oxygen-air blender can be used via standard nasal cannula to provide the lowest amount of fraction of inspired oxygen (FiO2) in order to reduce harm2. A recent Pediatric Acute Care Cardiology Collaborative (PAC3) Hospital Survey indicates that 88% of participating acute care cardiology units (ACCU) provide blended oxygen to patients, however, indications for use are not well-established3,4. A local ACCU nursing staff survey revealed mixed use of blended oxygen and variable understanding of current oxygen weaning orders and protocols. A literature search did not provide sufficient guidance on oxygen use best practices in patients with congenital heart disease. We sought to evaluate the current practice of oxygen administration in our ACCU.
Project Design:
Data extraction from PAC3 registry for local ACCU encounters on oxygen use for patient encounters since October 2021. Multidisciplinary group convened to outline patient and data field inclusion criteria. Data evaluated for all ACCU encounters for patients on supplemental oxygen via nasal cannula. A gap analysis and a process map were utilized to better understand the current state.
Results::
704 ACCU patient encounters used supplemental oxygen, of which 14.6% utilized blended oxygen. Analysis revealed confusion of electronic medical record (EMR) oxygen weaning led to varying approaches for choosing amount of flow versus amount of concentrated oxygen (FiO2) as the weaning mechanism. Additional causes included standard use of blenders in the cardiovascular intensive care unit, a knowledge gap of the proper indication for blended oxygen, and lack of guidelines for weaning oxygen.
Conclusion:
Best practice guidelines nor standard oxygen weaning protocol exist for blended oxygen use in patients with congenital heart disease. Future steps include analysis of patient-specific factors related to the use of blended oxygen to establish best practice guidelines.
References:
1. Dietrich Klauwer, Christoph Neuhaeuser, Josef Thul, & Rainer Zimmermann. (2019). A Practical Handbook on Pediatric Cardiac Intensive Care Therapy. Springer.
2. Walsh, B. K., & Smallwood, C. D. (2017). Pediatric oxygen therapy: a review and update. Respiratory care, 62(6), 645-661.
3. Hoerst, A., Bakar, A., Cassidy, S. C., Clabby, M., Grippo, E. D., Graupe, M., ... & Pediatric Acute Care Cardiology Collaborative (PAC3). (2019). Variation in care practices across pediatric acute care cardiology units: Results of the Pediatric Acute Care Cardiology Collaborative (PAC3) hospital survey. Congenital Heart Disease, 14(3), 419-426.
4. Pediatric Acute Care Cardiology Collaborative (PAC3) hospital survey, Version 3.0.
Publication Date
9-27-2024
Keywords
Research
Disciplines
Cardiology | Pediatric Nursing
Recommended Citation
Walsh, Melanie; Birely, Alexandra; Mahmalji, Sarah; and Patel, Sonali S., "Evaluation of Supplemental Oxygen Use in the Acute Care Cardiology Unit and Opportunities for Standardizing Practice" (2024). 2024. 1.
https://scholarlycollection.childrens.com/nursing-anf2024/1
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
