Nasal Cannula Oxygen

Specialties NICU


this seems ridiculous to ask, but please realize i've been away from nursing for a few years and still have some cobwebs in my head...

my question seems to have to do more with common sense rather than anything else because, although i've researched all my books at home, i can't find anything about this in one of my many nursing books...

example: a baby is on nasal cannula oxygen flowing right out of the wall through a flowmeter. (nothing special like cpap through nasal cannula, etc.) he is receiving between 25 and 50 cc pressure and doing well, keeping sats in the ordered 90-95% range. i know 25cc is barely a "whiff", but for some tiny babies it makes all the difference...

i leave his bedside for a few minutes with him on 25 cc with sats around 93%. when i return to his bedside i see him satting 85 so i go to turn up the flowmeter and find someone has turned the flowmeter down to zero (no flow coming out of the flowmeter) and he is still wearing his nasal cannula. i quickly turn the flowmeter back up to between 25 and 50 cc and he very quickly begins to raise his sats to the low 90's. i don't know who turned the flowmeter off like that and since i'm new in this unit and didn't see anyone do it, i figure maybe something is wrong with the equipment and i thank god for monitors that beep.

an hour or two later, another kid on the same type of oxygen is satting 98-100% on 25 cc and her monitor keeps beeping. her nurse is away from the unit. i keep going over to her pod to see why the monitor keeps beeping and realize she's not really needing any extra oxygen to sat well. while pondering this thought another nurse comes up and i say, "she's satting 98-100 on 25 cc nc. do you know when her nurse will be back?" and the other nurse reaches over and turns the flowmeter off and says, "when they do that we just turn it off."

now where i came from, if a kid was satting high on 25 cc, we would turn the flowmeter off and take the nasal cannula off too. the reasoning was that if there is no air flow coming out of the prongs then the prongs staying in the nares would be occluding them enough to cause the baby to desat... babies being obligate nose breathers and all...

so, i mention this to the nurse as we watch the baby begin to desat in about a minute after she turned off the flowmeter. i turned it back on and we watched the baby's sats come up right away. she said, "you know, what you say makes sense; i never really thought about it that way."

my question to you is this: when you have a baby on nasal cannula at 25 cc pressure, and he/she is satting higher than the doctor wants, do you remove the nasal cannula from their nose or do you leave the cannula in their nose and turn off the flowmeter?

i've only worked at one other nicu so i have no other reference points to help me out here. this is why i depend so much on all of you!!! thank you in advance for any input you have for me. i don't really want to say anything to my preceptor about this until i know if my old hospital was strange or if they were correct in removing the cannula from the nares when no flow was coming out of the tubing... besides that, as i said earlier, i can't find any reference to this in my books... sure wish i had a respiratory therapy book. even my "ventillation for the neonate" textbook says nothing about this...

looking forward to your replies!!!:kiss


8 Posts

Well, coming from a new grad myself, I'm not sure if I'll answer this right, but I will try. And I'm sure some of the more experienced nurses will reply as well.

In your post you only mentioned the "flow", however, when a baby is on NC, there is usually a flow and it's also very important to note the percentage of oxygen being delivered; can be anywhere between room air (.21) and 100 percent. You will have some sort of respiratory management plan that will state exactly the parameters that the baby should be in. Such as "keep sats between 85-95%" IMO, if your baby that slowly began to desat, I might give him a little more O's, depending at where the MD wanted him, and knowing that too much O2 can be harmful. So to me it seems like a juggling act. Increasing the Os would thus (hopefully) increase the Sats, whereas increasing the "flow" is not delivering any higher amount of oxygen.

So as far as your baby on 25cc...was it RA? or some higher percentage of o2? And YES if you had AN ORDER to d/c the NC in efforts to wean the child from the NC, then you would take it off and "see" how the baby handles it. Sometimes you'll have some chronic lungers who need that small amount of flow to keep their Sats up...

IMO (which is very new) I think what the other nurse did was wrong, expecially if she didnt know the child, didn't know the orders, and did it and walked away from the bedside. That's my two cents..someone else hopefully will reply!

Ya know, I just reread your post before replying and I really didnt answer you're question. And you probably know everything that I said in my post, but I'm just gonna throw it out there anywhere! So if it was RA and 25cc, I would make sure the MD wanted to wean her off, and take the prongs completely out. B/C the baby can exhale around the prongs, but it would be difficult to impossible to inhale around the prongs I would think.

Mimi2RN, ASN, RN

1,142 Posts

Specializes in NICU.

If a baby is consistantly satting high, we turn the O2 as low as it will go, to wean the baby off. The problem is that because he has episodes where he sats high, it doesn't mean he is ready to do without altogether, so you do have to know the report, in charting....and no one else should ever turn the oxygen off! It is neither another nurses right or responsibility to make that kind of a decision. Did she bother to document what she did? You may have to bring this up with her....or maybe at a staff meeting, without naming names.

As far as removing the nasal cannula, we will leave it on, sometimes take the prongs out of the nose, but keep it on the head.......if you have it taped on, it's easier to restart, and less trauma to the skin than having to retape it on. It all depends on the baby. BTW, babies do manage to breath with the prongs in the nose and the O2 off. Also a baby can keep his/her sats up when the prongs have migrated to the mouth, as long as the oxygen is on....turn it off and they desat.

We have babies with O2 down to 1/8 or 1/16 L, who hang in there, but take it off and their sats drop. Sometimes we have several attempts at weaning before we are successful.


17 Posts

In my opinion, your example addresses several different issues. First, You stated the NC was connected directly to the wall flowmeter. So, I am assuming the FIO2 is 100%. And you are adjusting the liter of air flow. So 25cc would be about 1/4 of a liter. Just a whiff of O2 with a breath of air pressure. I work in a level III nursery. We usually reserve connecting the NC directly to the flowmeter to the babies we are trying to send home on O2. When home, these babies won't be on a pulse ox. We observe to be sure they will be stable when they get home. So, we wouldn't be turning the flow off.

Our babies who are unstable and on a NC, are connected to an O2 blender and flowmeter. Our Neo's order the liter flow and the O2 saturation limits. Usually 1/2 to 1 liter air flow. And 98-88% saturation. The nurses use judgement and adjust the FIO2 to keep the sats within limits. However, the Neo's order the continuous use of O2. So, we need an order for the NC, and we need an order to D/C the NC. It is considered a drug. Exception being in cases of immediate need. If the baby needed it, we would use it. Then get an order for it when the baby was stable.

Second, I'm with you If the prongs are large enough to deliver enough air and O2 to keep a baby stable, I would think they would also be big enough to block their nares. If I thought the baby no longer needed the flow, then they dont need the prongs in their nares. Don't be lazy, reach in the bed and take the NC off. It's not that much more work!

Finally, while our unit fully believes in teamwork, there is a reason why the charge nurse makes assignments. I am responsible for the baby I'm assigned to care for. I know the most recent history of that baby because I am the nurse who received report when accepting my assignment. My coworkers would adjust the FIO2 for my baby if the baby's sats were out of limits and I was unavilable. However, we would never, ever, turn O2 off. And then walk away without saying something to the nurse. Not only is that rude, it is dangerous.

Hope this helps.

Well #1 : You are right. You are blocking the childs air supply by turning off the O2 and leaving the NC in!!! Scarey nurse!

#2 We need an order to turn off O2.

#3 We also use a blender so we only adjust the O2 percentage in accordance to the sats. Again, need a docs order to turn flow down to say 1/4 liter.

Geez! I still can't get over how dumb that nurse was!


82 Posts

the nasal cannula makes it very difficult to breath around if you're not getting an O2 or should always be removed....there are lots of people that don't grasp this idea our unit...we can dc the flow and 02 if baby doesn't need's totally up to the nurse.....


208 Posts

Thanks everyone for all your responses!!!!!

I'm still of the belief that if there is no flow coming out of the prongs then the nasal cannula needs to be removed from the babies nares. I'm glad to know so many of you agree with me. (By the way, I'd never stop oxygen administration without an order but as most NICU nurses can agree, we often are able to wean oxygen as a trial and if it works we let the MD/NNP know so it can be officially be discontinued. NICU nurses usually have increased autonomy in this area especially since unneeded supplemental oxygen is documented to be detrimental to the babies... we all understand the importance of stopping its administration with its no longer needed...)

My problem now is to find some "literature" to document this belief but I'm having a really hard time finding "common sense" measures documented in a text or study. I'm thinking about calling the CNS at my previous hospital to see if she has something I can use to back me up on this point... If you know of anything, please, please let me know about it. Do you have a policy in your P&P manual that speaks to this point?

Being so darned new (today was my 5th day working there), I really don't want to come in like a tornado trying to tell them how to run their unit. I feel like I'm in between a rock and a hard place. I don't want them to say something like, "Well then, why don't you go back to your previous hospital if you don't agree with the way we do things here?" if you know what I mean...

They have a respiratory therapist (RRT) who stops by the NICU to check on the babies and attend sections. When he came by today I asked him about this. Would you believe he said they turn the flowmeter all the way down but leave the nasal cannula prongs in the nares! He said his belief is that there is enough air for the babies to breathe around them. I explained the rational we had for removing them at my previous NICU and he just couldn't wrap his mind around it. I ended the conversation nicely by saying I've got a lot to learn about how things are done here and thanked him for his time. Oh Gosh I hope I at least planted a seed! A lot of times people will rattle off automatically their answer before allowing time for the information to sink in first.

Thanks again to everyone who has answered my question and I look forward to hearing from anyone else who would like to comment on this topic.

You all are the BEST!!!!


How about jaming a couple of pens up their noses so they get it?


208 Posts

:rotfl: :rotfl: :rotfl:

If only I could...!!!!!


33 Posts

Specializes in NICU,ICU,PACU,IV Therapy.

As a former nicu/picu RRT and now a nicu RN it has been my experience that when you have an infant on 25cc nc (which is 1/40th of one liter or 1000cc) you can turn the flowmeter down to approx. 20cc or less if you do it right. If the infant is still saturating high take the cannula off depending on the style of cannula, ie premie, neonatal, infant sizes. if you feel that the infants cannula and the size of the nares are bigger, leave it on to do the RA challenge. Remember there is more than one way to do things. :roll

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