High Flow Oxygen

[LovinIt2010]

I was just curious for future reference. I had a patient recently who required high flow oxygen by nasal cannula. She also received an order for an NGT. Is it possible to use one nare for high flow and insert NGT through alternate nare? My charge said that defeats the purpose and would reduce the flow by 50%. I disagreed and reasoning that tubing would operate similarly under higher pressure with one hole.. as in a garden hose.. yes? He looked at me like I was an idiot for asking. Respiratory said yes they do at times do this. My patient ended up refusing the NGT and going to surgery. Please share your protocols and experiences under these circumstances :) Thanks!

[blondy2061h, MSN, RN]

The NG shouldn't be so big it totally occludes the nare

[KatieMI, BSN, MSN, RN]

Had this pretty often when I was in LTACH. If NGT didn't stay there forever, it worked just fine as long as the patient could breathe with his nose. If within 96 hours or so there was no alternative to NGT, it was usually changed to Dobhoff because the nare could get clogged with dry secretions and other debris. It didn't really cut 50% oxygen off and only was a concern because HF oxygen is really drying and we wanted to avoid sinusitis, bleedings and ulcerations.

The thing that had to be watched closely was skin around nose. HF cannula has to fit closely, and yet another tube in the area increases risk of pressure injuries.

[LovinIt2010]

Thanks for the feedback! It would have needed to be NGT for suction. However, ideally temporary.

[KelRN215, BSN, RN]

In pediatrics- especially cardiology or kids with various congenital defects that affect the respiratory system and swallowing, kids are on O2 and NG feeds all the time. The NG tube isn't that big. They have an NG tube in 1 nostril and the nasal cannula still goes in both.

[Guest374845]

There's a big difference between an 8fr dobhoff and a 16-18fr NG. If your pt required a true NG for decompression, one of the two cannula prongs probably wouldn't fit in that same nare. Or it would but it wouldn't actually deliver O2 very far.

With regard to how much this reduces your pt's FiO2... depends how high "high flow" is. If your pt was using a vapotherm at 50LPM it could be a serious reduction. But if it's 8L, you could have just watched his sats or done a blood gas to determine if a flow increase was needed to compensate for the effective drop in FiO2.

Regardless, if a pt needs an NG they need an NG. It's up to you to work with RT or within your own knowledge to figure out the logistics.