Do you use oxyhoods?

[NeoPediRN]

I just started a per diem pedi job in a small community hospital. When reviewing with the nurse educator, I learned oxyhoods are the standard of practice here. I was very surprised to hear that as I've never used them elsewhere. We usually use high flow for higher FiO2 requirements or an infant nonbreather absolute worst case scenario. Do you use oxyhoods in your units?

[TiffyRN, BSN, PhD]

Pretty much the only thing they are used for anymore in my unit is for older gestational age infant with a pneumothorax. I do not understand how it is supposed to help but I am told it is supposed to actually help with the pneumo, not just increase the infant's sats.

[littleneoRN]

The hoodbox for the pneumothorax is 100% FiO2 for a nitrogen washout. The administration of 100% oxygen to term infants ("nitrogen washout") is said to potentially resolve the pneumothorax more rapidly. The theory is that nitrogen in the air contained in the pleural space passively diffuses across lung into alveoli full of 100% oxygen. This encourages resolution of the intrapleural air leak.

We use hoodboxes for preemie RDS kiddos who do not need CPAP or intubation. One of the reasons is that you can accurately measure the FiO2 needed. The FiO2 delivered by cannula is estimated at best and varies with the liter flow and accuracy of the blender. I have never ever used a non-rebreather mask on a newborn. Just nasal cannula, hoodbox, or something more invasive.

[Deidre Shiobhan]

I just started a per diem pedi job in a small community hospital. When reviewing with the nurse educator, I learned oxyhoods are the standard of practice here. I was very surprised to hear that as I've never used them elsewhere. We usually use high flow for higher FiO2 requirements or an infant nonbreather absolute worst case scenario. Do you use oxyhoods in your units?

Yes my unit still do infact the humidifier that we are currently using is not going to be manufacture anymore.

We are soucing for vendor to see how we can settle this issue.

[EricJRN, MSN, RN]

We rarely use them... and we never use NRB's, though I know anesthesia uses them briefly in some of our post-op kiddos.

[NeoPediRN]

We don't use nonrebreathers where I work now as we have access to high flow and CPAP/BiPAP, but in a previous hospital they were all that was available for infants in an emergency with high oxygenation needs, except for an ambu bag.

[Love_2_Learn]

We use oxyhoods occasionally in our NICU as well. We use them on term babies with small pneumothorax for the nitrogen washout purpose. We flush them with 100% oxygen and they are humidified as well with warm humidity. The analyzer needs to be near the baby's face too so you will know the concentration of oxygen that the baby is breathing (there can be pockets of are flowing around in the hood that are not 100% so you need to have the analyzer nearest the baby's nose as possible. Since we are using 100% oxygen we never use them on preterm babies or this could contribute to ROP. It works pretty well and the babies are usually fine after a day or two and the hood is removed then.

We also use oxyhoods to give 100% oxygen to term babies who are presenting with potential cardiac anomaly and the physician wants to test their arterial blood gases before being on 100% oxygen and after on it for about 30 minutes because looking at the pO2 of both the gases (drawn preductally and postductally generally) helps them to make a determination as to whether the baby's problem is heart or lung related. It does not make a definite determination but helps in the diagnosing of their problem.

littleneoRN explained well about why the hood is used for delivering 100% oxygen rather than using the nasal cannula. We use a lot of nasal cannula on warmed, humidified air with oxygen blenders. We use from 1 Liter/Minute flow up to 3 L/min; occasionally 4 L/min but rarely and only on big kids. Often times the babies just need the air flow to keep from having apnea and to keep their blood gases stable and don't need much oxygen from the blender at all.

I've never used a rebreather mask on a baby in NICU.

[NICURN29]

In the past, we have rarely used oxyhoods for term babies with pneumothorax to administer 100% FiO2. We do not do this anymore, however, and one of our docs told us a few weeks ago that there is some research that using 100% FiO2 in this way has been correlated to the growth of abnormal cells (i.e. cancerous cells) in the body later in life. I don't have any sources to back up that information, although I do believe that he has found evidence to back up that claim.