nc 2L-3L

We rarely use NC oxygen at that high of a flow without a blender. Generally >0.5L/min gets a blender. We are not using much high flow NC (we consider high flow >0.5L/min) since we got Vapotherm and that's always blended. Also the highest flow I've seen used with regular NC is 2L/min. We use Vapotherm up to 8L/min.

we do not have a vapotherm but it is a practice in this hospital to give NC 2-3L. there are times they used the blender and at times not.

there was one baby handled by one of the preceptors who was on NC@ 3L O2 with blender @ 40%, eventually the baby was weaned down from the blender until it reached 21%. however, he still remains on 3L for a few hours. it was weaned down to 2.5L then to 2L, down to 1.5 up to 1L (still without the use of the blender),not until another NNP came in and have noticed it on the shift change.

the baby's nose is somewhat raw and blasted. no incident report was made.

If this doesn't fall within your unit's policy then perhaps an incident report is warranted but the series of events you described doesn't sound out of line to me unless you meant the infant at some point returned to 100% on the blender. If the infant did remain on 21% while weaning flow, that sounds OK also, we have kids all the time that need that flow but no extra O2. If the MD/NNP ordered the infant to be at 3L/min then the flow is likely the culprit in a raw nose, not the high FiO2. In our unit with high flow blended O2 the nurses wean FiO2 but not flow unless the MD/NNP specifically states to wean the flow (which is rare). Unfortunately this high flow O2 will make their little noses raw and dry (even with humidification). That's one reason we love our Vapotherm.

There is a great variety of methods and philosophies from unit to unit. It is important to find what is the standard at YOUR unit. I know when I worked cardiac telemetry as a traveler I found that what was standard procedure at one unit was something that would get you written up for at another unit.