RT Clinic : Heated High Flow Cannula

[@kellyphillips9770]

I was hospitalized for severe COVID and was hooked up to high flow oxygen. They eventually began weaning me down to the lower level type of oxygen. I had some serious problems with oxygen. It would severely dry my nose out. The dryness would cause nose bleeds all the time. That blood would choke and gag me. At times I had Hell breathing because my nose was so stopped up with huge blood clots and dried snot build up. It was awful. Glad they are tinkering with things to make life easier on patients.

[@rtclinic]

I'm so sorry about your experience with nose bleeds! It sounds horrible.

[@brianbernal9470]

​@rtclinic can you do video on full face mask cpap

[@alismom2335]

We use a vapotherm at our hospital and it's very similar. It's fairly new but getting popular among the physicians. Especially with our closterphobic patients that cannot tolerate bipap. Great tutorial 👍

[@rtclinic]

Thank you! I plan to make a Vapotherm specific video in the future for pediatric therapy.

[@krisicke4942]

@@rtclinic My relative is on hfnc, complaining that is too hot. What can I tell the staff to make sure there doing it correctly? Also he is on 40 litres per min and fio2 is at 90-92% is there a way I can bring him home? The staff is telling me that because he is on high flow at 40, it's not recommended he leave the hospital. We wanted to buy the equipment but I was told that I wouldn't be able to find any proper equipment to keep him at 40 lpm.

[@rtclinic]

@@krisicke4942 Great questions that I would be asking too. #1 if the setup looks like this one, then there are two heat settings 31 degrees Celsius and 37 degrees Celsius. If it is on 37, you can ask if they can turn it down to 31. #2 . 40 liters per minute is a lot of flow to go home, but more important than that the 90 % oxygen (fio2) cannot be maintained with any device at home. The goal should be to wean the fio2 to 50% or so then try to decrease the flow. Then transfer home might be more feasible.

[@krisicke4942]

@@rtclinic thank you Jimmy. Calling hospital now. 🙏

[@krisicke4942]

@@rtclinic also is 4 litres equals 40 litres, 5 litres equals 50 litres, 6 litres equals 60 litres etc? Is that how it works?

[@shanshan8113]

This is awesome! Have my midterms for RT tomorrow

[@vinodsmita2017]

Thank you for nice demonstration

[@CynthiaReber]

Clear and helpful. Thank you!

[@Suzi_P]

This is so much helpful. Thank you so much. Could you please post more videos please?

[@jessiesupnad5595]

Sa gc ng census bureau chief for you you are asleep and and the other hand I know you you are not alone in your philhealth id ka na sa obw station na cla na lng at the end of ko kayo sa labas ng labas at least a great privilege working in this field is not

[@Kitzishot]

Thank you for the tutorial but when I hear an RT talk about hypoxic drive and treating every CO2 retainer as being on one it really speaks volumes that the RT has never really seen a patient that truly is on a hypoxic drive (what RT's should be worried about is V/Q mismatch resulting in the Haldane effect in those end stage COPD patients who can't increase their VE but once again those are very end stage COPD) When you actually meet one you never ever forget it. You are looking at Co2 in the 120+ range with the ph in the acidic range of normal. It isn't as simple as just keeping their Saturations between 88 to 92. They'll require a lot of Oxygen just to maintain those saturations. What happens is they will stop breathing, their saturation will drop to around 84 or lower, they will take a breath, and it will shoot back up to the high 80's to low 90's, and the cycle repeats. Because their Co2 is so high you really want to minimize Metabolic Acidosis and if you don't get the O2 right you can send them spiraling. It is really really high maintenance to keep their work of breathing down (even though their work of breathing will be high) and their skin will be dusky, grey, and they will be thin and malnourished. It's the very end of end stage. I've only had one patient that I believe was on a hypoxic drive and I'll never forget it. It's very rare and it takes a hell of a lot to burn out the Hypercapnic drive and even then I'm so sure it's actually burned out. In short: You should really only worry about keeping the O2 saturations between a certain range in those end stage COPD patients who can't increase their VE and it will be really evident on what type of patients those are when you see them.

[@ranajit45]

Excellent. Very relevant in 2020 A practical aspect is the management of oxygen supply which is very high when large number of patients are connected in a Covid-19 hospital. One can refer to a video " HFOT Calculator" on KZbin as a supplement to this nice video.

[@justinhapner5605]

Thank you for the tutorial!! I'm a critical care RN and we are now commonly using OptiFlow devices for COVID patients. I have talked to many of our RTs about these devices in the past, but your explanation gave me a whole new level of understanding. I def feel more confident in my knowledge-base, as I am constantly attempting to wean patients. I was wondering your perspective on the appropriate level to wean patients to a traditional (15L) HFNC? In my setting, it seems that we tend to do this when the patient has been adequately tolerating the OptiFlow on 40%/40L for some time... what is your take??

[@rtclinic]

Yes. 40 and 40 is pretty much where want to be. I wouldn't go before below 40 lpm, but you could go down on the FiO2. The covid patients respond so well to those high flows and the little bit of CPAP it creates.

[@justinhapner5605]

@@rtclinic Thank you for the feedback!

[@nursechrissymarie2865]

Thank you so much!! ***NICU RN

[@florangelahinckley8455]

Very well explained, thank you so much

[@rflf2007]

Most of the patients in the hospital complain when the heat is on 37. They say it is to hot.

[@djshy_boogie2192]

There are 2 different temps the 37* is for invasive mode if they’re intubated . Hold the top right button changes it to non invasive and brings it down to 31*

[@connercollins1450]

@@djshy_boogie2192 the video guy said the only way you get proper high flow is when the heater is on 37*

[@catherineasadi9226]

Really useful as we enter the acute phases of the corona virus and these will I guess become more familiar in previously less critical areas. Thank you

[@irvinarana8523]

Great review.

[@feiyunxu3495]

Great video, learn a lot, thank you!

[@rt.asmaalshammari]

Jimmy you are amazing !! Thank you so much for this video!!

[@rtclinic]

Thanks for watching!!

[@panedole]

Winner of a video, I've been looking for "can a cpap machine tell if your asleep" for a while now, and I think this has helped. Ever heard of - Cenatthew Harrowing Cure - (Have a quick look on google cant remember the place now ) ? It is an awesome exclusive product for discovering how to end your sleep apnea problem without the normal expense. Ive heard some amazing things about it and my mate got amazing success with it.

[@ma.teresaasprec9017]

Hi Sir Jimmy! I have a question. When refilling the humidifier, can we use PNSS as a substitute for sterile water?Thank you!

[@rtclinic]

You could use a plain normal saline solution, but it might cause a buildup if you use it for a long period of time. For a couple days it should be ok. Thanks for the question😁

[@ma.teresaasprec9017]

@@rtclinic thanks Sir Jim!👍👍😊

[@ADGMoN3y]

If the heater isn’t turned on is it considered “cold flow”.

[@rtclinic]

We just call it a high flow cannula, but we don't go over 15 lpm with them..

[@edgarp32001]

Thank you so much. It was clear and extremely useful

[@mechmania8450]

Do you have a pdf on this ? I have so many questions.

[@rtclinic]

Unfortunately, I dont. I'm open to a zoom meeting to answer questions. Let me know.

[@ashleyjackson8595]

@@rtclinic . What is your zoom meeting link code so I can see you on Zoom whatever I want

[@LegioXIVGemina]

Thanks, new ED design underway and we want to get it right

[@rtclinic]

If you add medical air to every room, you'll be able to better control FiO2 to CO2 retainers and give all nebulizers on med air instead of oxygen. Med air is ideal for neb delivery with causing hyperoxia. I think supplemental oxygen use will go down in the next decade because of the possible harmful effects of free radicals. Unfortunately, Med air in every room will blow your budget!

[@connercollins1450]

where did you get your research from saying it has to be on invasive 37*???

[@rtclinic]

Ideally it needs to be on 37 degrees, but if your hospital allows changes to the temp...31 will work if requested by the patient.

[@michellemckay5992]

Can you link the calibration video? Looking for one for my RT students!

[@rtclinic]

The o2 cell calibration?

[@michellemckay5992]

@@rtclinic yes!!

[@pollyanarocha5928]

I am looking for the analyzer calibration video and can't find it. Can anyone let me know where is it located?

[@rtclinic]

I need to do a quick one. This is the 2nd question about it.

[@rutheragonoy2062]

Can the O2 source be from standard 10LPM oxygen concentrator? Or it has to be pressurized tank?

[@rtclinic]

This device needs a 50 psi source, but the Airvo can use a home concentrator.

[@rutheragonoy2062]

Jimmy McKanna - RT Clinic Airvo is just a humidifier tho right? It wont increase air flow to high flow like 30-50lpm?

[@rtclinic]

@@rutheragonoy2062 Nope. The Airvo humidifies and increases the airflow to high flow rates. Supplemental oxygen is added and the Fio2 is calculated on the display screen. I like to think of it as a home unit CPAP that is used for a high flow cannula.

[@rutheragonoy2062]

Jimmy McKanna - RT Clinic amazing thanks!

[@Haytham93]

1st let me thank you for the information, and I think this is the right time to make mass production from this device. when most of us think about Ventilators. As I heard this device is fair enough for som of Coronavirus Patient that are not in Sevier condition, so is there any manufacturing information that can help? Thank again for your precious Information

[@rtclinic]

One of the most important aspects of this cannula is heating and humidifying the air to 37 degrees C. Without the heat and humidity this therapy will not work.

[@mustbeeb]

@@rtclinic but what about covid19 patient..is it helpful for them ?

[@jasonr721]

@@mustbeeb Yes HFNC is very beneficial. Look up Unity Points recent reseach as well as Dr. Gerard Criners new research out of Temple. They have been managing the majority of their covid base outside of the ICU by starting COVID patients on high flow the moment they present to the hospital. In both sets of research the starting flow is between 35 to 50 LPM at 100% FiO2. Using high flow as a first line tool will prevent a ton of intubations and free up ICU beds

[@Kbhgdfjvf]

What is the danger of using high flow. My father died after taking high flow in 3 days. Does aviola damage due to high flow. How many dosages patient should take.

[@rtclinic]

There is very little risk associated with a heated high flow cannula. Since it is heated it mimics the natural humidity of the airway. There is a small

[@LegioXIVGemina]

I’m guessing that the O2 source requires a different wall connection than the standard ED type used for nasal cannulas.

[@rtclinic]

This heated high flow will fit the 50 psi connector that is used for the flow meter. If the flow meter ca be disconnected from the wall, this device will work for you.

[@lalaxo2310]

Had to be on one of those before and I hated every second of it

[@TraditionswithaTwistbyDrMadhav]

Can it helps to reduce wob in weak respiratory muscles

[@rtclinic]

Yes, definitely.

[@peterfslife]

Watching you do that without the Heater Humidifier on made me CRINGE!!! When you put it on without the heater turned on, I was thinking in my head "TURN THE HEATER ON FIRST!!!! PLEEEEEEEASE DON'T DO THAT WITH DRY COLD AIR!!!!

[@rtclinic]

In hindsight, I should have turned on the heater et let it heat up. The splitting sinus headache and dried up nasal mucosa that ensued for two days was a perfect representation why it HAS TO be heated and humidified. A good lesson for me.

[@anuarvind1016]

Thanku so much sir !! This has been very helpful 😊

[@bxglizzo8]

Thank you so much!!!

[@andjelkabarzetovic5181]

Thank you so much

[@jlevi0071]

If soiled and encrusted how often change cannula?

[@rtclinic]

If it has any sign of being soiled, I would replace it. After about a week, they can start to become rigid. Replace it at that point because the cannula can cause breakdown on the ears.

[@hanwin651]

Thanks a lot !

[@mahaarshad3483]

What you are saying it's must be write down below with your videos plz

[@rtclinic]

I'll try to add subtitles

[@genesissanchez1813]

Hi! Vsause here

[@arinimawardi4796]

Halo everyone I would like to ask is that fine if we use sterile water for the water irrigation or normal saline?

[@rtclinic]

Sterile water.

[@ashleyjackson8595]

I am wearing a nasal cannula for help my pretend patient with severe asthma attack to breathe each night

[@driealee1441]

What are the side effects or danger of this treatment?

[@rtclinic]

I've not heard of doing that before...

[@manuelartmann4644]

Nice

[@shelleyrightmyer6421]

Love ti somuch miss

[@JohnnyWishbone85]

10:11 -- Boy, did we.

[@juliachambers725]

👏

[@MalluStyleMultiMedia]

cool

[@H0tSauceGG]

How would you incorporate a neb treatment on a patient on a heated high flow device?

[@rtclinic]

I would give them a mouthpiece nebulizer. I've seen some put them inline but I think it is too much velocity for the aerosol.