ALERT: How to ensure safety when caring for a child on a heated high-flow (HHF) device?

Connected Care Quick Hits are up to date and evidence based recommendations for the care of children with medical complexity & technology dependence, from hospital to home.

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ALERT: How to ensure safety when caring for a child on a heated high-flow (HHF) device? 

SITUATION: 

This Quick Hit was informed by questions from nurses that are caring for children with medical complexity on heated high-flow (HHF) devices in home and community settings.

BACKGROUND:

The use of HHF devices (e.g., Airvo) has increased in recent years among children with medical complexity in home and community settings. HHF devices provide warm humidification which improves comfort and promotes optimal humidity. The purpose of the HHF device is to maintain clear airways and promote the removal of pathogens through secretion clearance. HHF devices are not a form of ventilation and require device specific safety checks to be completed at the beginning of each shift and on an ongoing basis.

ASSESSMENT:

The HHF humidification system has multiple components that need to be set up correctly for the unit to function as intended. The following equipment and set up is required for use in home and community settings: 

• Airvo

  • Home unit: MyAirvo or MyAirvo2

  • Hospital unit: Airvo or Airvo2

• Tubing

• Water canister

• Interface

• Water bag (filled with sterile distilled water)

• Oxygen (if prescribed)

• Plug into A/C power (no internal battery)

Once the HHF device is set up, ensure that the appropriate medical orders are in place for use. A complete order for use of a HHF device includes:

• Name of Therapy: Heated High Flow Therapy (e.g., Airvo)​

• Daily Schedule for Use: E.g., at night during sleep​ and for naps

• Interface: Nasal cannula, face mask or tracheostomy adaptor​

• Temperature Setting: Either 31, 34 or 37 degrees Celsius

• Flow Setting: Number in liters per minute (Lpm)

• Oxygen prescription: FiO2 setting (on MyAirvo) or a Lpm setting (MyAirvo2)

RECOMMENDATION:

Connected Care recommends the following to ensure safety when caring for children receiving humidification via HHF devices in home and community settings:  

1. Verify the HHF settings with the child’s orders at the beginning of each shift and understand their airway clearance protocol (e.g., when to provide routine and prn suctioning).

2. Assess the child’s respiratory status before, during and after therapy.

3. Ensure the water canister is filled with sterile distilled water to the appropriate level that is indicated on the device.

4. Prior to use, ensure the device has warmed up and that the unit is ready to go (green checkmark on screen). Verify that the tubing is warm to touch as well.

5. Confirm that the child has an appropriate interface. If the child uses a nasal or face mask interface, assess skin integrity prior to use and during therapy.

6. Ensure the tubing is clean and connected to the interface before applying it on the child.

7. Replace the interface weekly and the tubing and canister biweekly or more frequently as needed.

8. Confirm that there is a back-up plan for humidity for travel (if needed) and in case of a power outage or unit malfunction.

9. Review the following AboutKidsHealth article that reviews the use and maintenance of the HHF device.

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