Oxygen is frequently administered to infants and children in the hospital setting as part of the management of acute and chronic illness. Safe practice is paramount as inappropriate use of oxygen can be hazardous to the infant/child, e.g. in certain cardiac conditions. A complete systematic assessment must be undertaken to identify the child’s clinical condition prior to the administration of oxygen. The exception to this would be in an emergency situation where high flow oxygen is usually administered initially.

Oxygen is administered through:

• nasal cannulae;
  
• a simple mask;
  
• a Venturi mask;
  
• a non-rebreather mask;
  
• a head box.

• Oxygen-cylinder supply or central supply.
  
• Oxygen flow meter.
  
• Appropriate oxygen delivery device (nasal cannulae, face mask).
  
• Oxygen saturation monitor and correct size of probe.
  
• Oxygen tubing.
  
• Elephant tubing for head box.
  
• Oxygen analyser for head box.
  
• Consider humidification.
  
• Paediatric Early Warning Scoring chart.

• Wash your hands
  
• Place correct size of administration device in nostrils/over child’s nose and mouth.
  
• Secure as per local policy.
  
• Connect oxygen tubing to oxygen flow meter.
  
• Turn on oxygen supply to the prescribed flow rate.
  
• Monitor and record the child’s oxygen saturation level, heart rate, and respiratory rate.
  
• Note the work of breathing and the child’s colour.

All children who require oxygen will need ongoing assessment and monitoring of their condition. The amount of oxygen delivered and the device used should be recorded, as should the effectiveness of the treatment.

The amount of oxygen to be administered must be prescribed. Oxygen should be weaned and discontinued as soon as possible. Increasing oxygen requirements indicate a deteriorating infant/child.

Nasal cannulae should only be used to deliver a flow rate of 0–2 L per minute. If a higher flow rate is required, then an alternate device will be required. Humidification is not required.

Nasal cannulae consist of two soft prongs that arise from the oxygen tubing. The prongs are placed in the infant’s/child’s nostrils with the prongs pointing downwards. This will avoid undue pressure on the nasal mucosa. When using with infants, ensure the prongs do not completely block the nostril as infants are obligatory nasal breathers.

The oxygen tubing may be secured with an appropriate dressing. When used with an older child, they may be secured at the back of the child’s head, sitting over the pinna of the ear.

Ideal for low flow oxygen delivery, the prongs may become blocked with secretions and irritate the nasal mucosa by drying it out.

A simple face mask can be used to deliver oxygen of various concentrations by adjusting the flow rate via the flow meter. A flow rate of > 4l/min is required to prevent the rebreathing of exhaled carbon dioxide.

Face masks come in various sizes and should fit comfortably over the child’s nose and mouth. A good seal is important. Not all children can tolerate a face mask so careful planning and explanations are required. The child may not want the mask on their face. Face masks are not intended for long-term use. A simple face mask will deliver a maximum fractional inspired oxygen concentration (FiO2) of 50%.

A Venturi mask permits the delivery of various concentrations of oxygen: 24%, 28%, 35%, 40% and 60% depending on the colour of the barrel chosen and the oxygen flow rate.

One side of the coloured barrel indicates the percentage of oxygen and the other side shows then number of litres to set the flow meter. To alter the amount of oxygen, the barrel needs to be changed.

The use of a non-rebreather mask with a reservoir bag can enable the inspired oxygen concentration level of 99% with a high flow of 10–15 L/min. The high flow will prevent carbon dioxide from being inhaled. It should not be used if a high flow rate cannot be maintained. The high flow will keep the reservoir bag inflated and the bag should be inflated prior to use. A non-rebreather mask is for short-term emergency use only.

Head boxes are only suitable for infants of less than 9 months of age who require high flow oxygen delivery, and it can deliver a FiO2 of > 95%.

The head box is placed over the infant’s head with their shoulders outside. Elephant tubing is required to deliver the humidified oxygen to the infant.

An oxygen analyser is required and this should be calibrated to measure the percentage of oxygen being administered. This needs to be placed as close to the infant’s airway as possible. Gas escape routes should not be covered as a build-up of carbon dioxide will occur. The flow rate will need to be maintained to prevent carbon dioxide from building up.

The head box will mist up when humidification is being used, so monitoring the infant’s temperature is important – cold stress or pyrexia is most likely. Have an alternate oxygen administration device ready as the removal of head box will lead to a sudden decrease of oxygen concentration.

Consider placing a familiar toy in the infant’s line of sight.