How to Put On a Nasal Cannula

When patients need supplemental oxygen therapy, there are several oxygen delivery systems that nurses may use to deliver the treatment. The system used will depend on the clinical condition and the required concentration and oxygen flow rate. Nurses General Nursing Knowledge

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How to Put On a Nasal Cannula

The nasal cannula is the most common for delivery of low-flow rates(1). It is more comfortable and practical than a face mask and is best for long-term use. The nasal cannula can deliver flow rates up to six liters per minute, but the oxygen must be humidified at rates of four or greater. You may use nasal cannulas with hospital wall oxygen, oxygen tanks, or portable oxygen concentrators for home use.

Quick Overview of Nasal Cannulas

Table of Contents

The nasal cannula is a thin oxygen tubing system that delivers low-flow oxygen therapy directly into the patient's nares. A threaded connection on one end will attach to the oxygen source at the regulator connector. The other end comprises a slightly thinner tubing loop with two prongs attached and an adjustable slide to fit the face properly. The prongs may be curved or straight, and the tubing may include a tab below the prongs to help with proper placement. 

The nasal cannula comes in different sizes, from neonate to adult. The nurse must choose the correct size to deliver the oxygen therapy. If an adult receives a pediatric size, the prongs will not lie far enough into the nares to be comfortable for the wearer. If an infant or neonate receives a size too large, the prongs could occlude the nares and apply too much oxygen pressure in the lungs.

When is a Nasal Cannula Used?

Patients may need supplemental oxygen therapy temporarily or long-term to help deliver adequate oxygen to the tissues and brain. Using various devices, nurses can provide flow rates of up to fifteen liters per minute. The nasal cannula helps when a patient needs a low level of oxygen supplementation, and it can deliver up to six liters of flow per minute. The nasal cannula is effective, easily applied, and well-tolerated by most patients. Patients needing long-term oxygen therapy, such as those with chronic obstructive pulmonary disease, can wear a nasal cannula with minor irritation or limitation to activities of daily living. This device is flexible, and the patient may clean and reuse it for long periods. The nasal cannula is long and allows for freedom of movement, eating, and drinking while using.

How do Nasal Cannulas Work?

The nasal cannula delivers supplemental oxygen directly into the nasal passages toward the nasopharynx. The device is long and flexible, with one end that attaches to the oxygen source. The other end is thinner and has two prongs that rest inside the nasal passages. The device delivers oxygen continuously at a predetermined flow rate. The cannula does not supply positive pressure to the lungs. If the patient needs this, they will require a different system. The nasal cannula can deliver flow rates of one to six liters per minute. If the patient needs more than three liters per minute, the nurse must humidify the oxygen for comfort and to prevent damage to the mucosal membranes. For humidity, the nurse uses a bottle of sterile water, attaching it between the oxygen regulator and the nasal cannula. If used for neonates, the healthcare provider should humidify and warm the oxygen to prevent heat loss(2).

Do Prongs Go Up or Down?

Some nasal cannulas have straight prongs, and some have curved ones. If the nasal cannula has curved prongs, the healthcare provider should place them in the nares with the curve pointing downward. If they point upward, the device will deliver oxygen to the top of the nasal passage and can cause dryness or discomfort, especially at higher flow rates. When the prongs curve downward, the device will direct the oxygen further in the back toward the nasopharynx with less irritation to the tissues near the bridge of the nose. Curved prongs usually include a small tab attached to the tubing below. This tab will help position the prongs correctly by orienting it so that the tab rests on the upper lip, not on the nose.

Nasal Cannula in the Mouth? 

Sometimes, the patient cannot tolerate having the nasal cannula prongs in the nares. The healthcare provider should consider a different device if the patient has nasal polyps, a deviated septum, or some other nasal airway obstruction. The patient with excessive nasal congestion may be unable to breathe in the oxygen well and may wish to place the prongs in the mouth instead. The amount of oxygen delivered by placing the nasal cannula in the mouth is unreliable and may not be sufficient to support adequate oxygenation levels. The bacteria level in the mouth also poses cleanliness concerns. In these cases, nurses should consider an alternative oxygen delivery device, such as a simple face mask.

Step-by-Step Guide to Putting on a Nasal Cannula

  1. Select the correct size nasal cannula. The prongs should be long enough to enter the nares fully but not so wide to occlude them.

  2. Connect the nasal cannula tubing to the oxygen source and set it at the ordered flow rate in liters per minute.

  3. Place the prongs in the nares, curved downward if the prongs are curved. If the tubing has a tab below the prongs, it should rest on the upper lip.

  4. Place the tubing over the ears like a pair of eyeglasses(3).

  5. Bring the tubing down behind the ears and underneath the chin.

  6. Secure by moving the adjustable slide so the tubing is snug but not too tight. 

Caring for your Nasal Cannula 

Patients can use the nasal cannula for long periods and should clean it weekly with soap and water, replacing the devices about once per month(4). You should also replace the nasal cannula after recovering from any respiratory infection to prevent re-infection. To avoid oxygen delivery reduction, inspect the tubing regularly for holes.

Tips for Optimizing Comfort

If the nasal cannula is in place for long periods, consider padding contact points with gauze to prevent skin breakdown. Irritation can occur at pressure points behind the ears, below the nose, inside the nares, and underneath the chin. You may use a water-based lubricant in or around the nares to prevent drying and supply comfort, but you should not use petroleum jelly(5). 

Anecdotal Nursing Experience 

Nurses commonly use nasal cannulas in the clinical setting and can view them as benign. It is essential to use the correct size nasal cannula to observe for irritation of the nares and skin. Sometimes, you may place the tubing over the ears and secure it behind the head rather than under the chin. If used this way, pressure injury can occur due to the head resting on the adjustable slide. Therefore, you must carefully and regularly assess the skin.

STAFF NOTE: Original Community Post

This article was created in response to a community post. The comments and responses have been left intact as they may be helpful. Here's the original post:

Quote

When applying a nasal cannula, the curved part that goes in the nose, are the holes turned up towards bridge of nose, or down? I've seen several different nurses/aides do it both ways. I was wondering if there is a correct way to have the holes facing to deliver the oxygen effectively.

Answer:  If curved, the prongs should curve down like a snake's fangs. This position directs the oxygen flow to the back of the nasopharynx rather than up in the frontal nasal tissue, which can be more irritating.

References

  1. Elsevier Healthcare Hub. (2021, September 30). Oxygen therapy: Nasal cannula or oxygen mask - CE. https://elsevier.health/en-US/preview/oxygen-therapy-nasal-cannula-or-oxygen-mask
  2. Elsevier Healthcare Hub. (2021, September 30). Oxygen therapy: Nasal cannula or oxygen mask - CE. https://elsevier.health/en-US/preview/oxygen-therapy-nasal-cannula-or-oxygen-mask
  3.  MedlinePlus. (n.d.). Oxygen therapy in infants. https://medlineplus.gov/ency/article/007242.htm

  4. Mountain High Oxygen. (2013, June 21). How to properly put on a cannula tutorial mountain high aviation oxygen. https://www.mhoxygen.com/how-to-properly-put-on-a-cannula/

  5. MedlinePlus. (2022, January 17). Using oxygen at home. https://medlineplus.gov/ency/patientinstructions/000048.htm

  6. American Lung Association. (n.d.). Oxygen therapy: Using oxygen at home. https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/oxygen-therapy/using-oxygen-at-home

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Tina_Hayes

About Tina_Hayes, MSN, RN

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Tina is a nurse with over 20 years of experience in labor and delivery and clinical education.

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Specializes in Utilization Management.

I was curious, so I just checked in my nursing skills book. It doesn't specificy which way is "correct". I always apply them with the holes towards the bridge of the nose.

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Specializes in Rodeo Nursing (Neuro).

Had a patient one night asleep with the canula on the bridge of his nose, satting 96%. Since he clearly didn't need it, I took it off, and sats promptly dropped to 92%. Put it back, back up to 96. I guess he was absorbing it through his eyes. (True story.)

Ideally, though, the canula goes in the nares with the curve down, for comfort.

I don't think it matters much for absorption. But a patient with a heavy mustache may actually be more comfortable with it reversed, as my Dad was. I've also seen the little curved parts clipped short, so they don't actually go into the nares, and the O2 still gets where it's needed.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Usually, in the nostrils.

If they can't tolerate it, in the mouth (if they can) this is usually for the young ones on narcs/post op.

If they can't tolerate that, a "blowby"...

This is for generally healthy adults with no/minimal co-morbids.

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Specializes in IMCU.
sstutzlpn said:
When applying a nasal cannula, the curved part that goes in the nose, are the holes turned up towards bridge of nose, or down? I've seen several different nurses/aides do it both ways. I was wondering if there is a correct way to have the holes facing to deliver the oxygen effectivley.

I think curved down is the proper way, but I have had several disoriented pts end up with it in their mouth. They would be Satting just fine, but I would remove it, put it in the nare and then they would pull it out and throw it off, Sats alarm would go off, where it had been fine in the mouth. Since then I have allowed people complaining of a sore nose or who just didn't like it in the nose to wear it on the upper lip or in the mouth. It works just fine. Thank goodness that is one piece of equipment which works more often than not, lol!

Mahage

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Specializes in Mental health for two years, LTC.

Thanks everyone for the help!!

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I've had my end stage copd patients that put the cannula in their mouth when they are feeling more short of breath. They swear it works better. Otherwise in the nares....curved down.

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Specializes in psych, addictions, hospice, education.

When I was in nursing school, we were taught that if someone had a clogged nose, we should put the NC on the upper lip, with the prong things kind of wrapped around the top of the lip so air would go into the mouth rather than into the nares. Otherwise, the prongs go down, into the nares, or you're drying out the up-side of the nares rather than sending the oxygen into the respiratory system.

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No the curves go down so the openings go down towards the respiratory tract. I have then seen the tubing go behind the ears and down under the chin. Not tightly or they will feel like choking. I have also seen the tubing put on top of the head. I always placed under the chin. Just be sure it is all centered well so as to deliver correctly and be comfortable. Some places also have foam t cushion around the ears, and if using a long time it can also be humidified and should be if an infant or child.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Oh..by the way, nursing takes creativity, sometimes you place it on patients however they like it and however it works....

There is never one and only way...

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