HFNC – AIRVO 2
Standard Operating Procedure

Indications

Refractory hypoxemia despite optimized conventional nasal cannula and/or nonrebreather mask O2 therapy in individuals with an intact, acceptable respiratory drive.
COVID confirmed or suspect with refractory hypoxemia is considered an indication.
Adults: SpO2 <90%.

*COPD/CHF exacerbation requiring a minimal amount of PEEP.

Palliative respiratory support with no endotracheal intubation or non-invasive ventilation (NIV) support in the care plan.

A definitive airway is required for airway protection and/or respiratory support characterized by acute respiratory acidosis.
Complete nasal airway obstruction.
Use with caution if there is a history of facial trauma, acute sinusitis or otitis other projectiles being released as a result of helicopter rotor wash.

Confirm that patient is on <15L/min of oxygen. Note this is separate from the flow generated by the AIRVO unit that entrains ambient air. Most patients start at flows of 40L/min total with a titrated mixture of oxygen.
Confirm that patient can tolerate a 10 minute trial period off HFNC, using a non-rebreather facemask and conventional nasal cannula to determine patient tolerance when AC power is not available for HFNC; e.g. transfer between ambulance and hospital. A successful trial is confirmed by patient SpO2>88%.

HFNC is a possible AGMP. The literature and recommendations surrounding this is evolving. Maintain appropriate PPE for AGMP as per BCEHS guidelines (gloves, gown, face shield, respirator).
Complete a Point of Care Assessment and/or follow additional precautions as identified by the receiving facility to indicate Personal Protective Equipment e.g. Contact, Droplet and/or airborne precautions.
Perform routine cleaning and disinfection post transport. IPAC Home site.

Confirm that above parameters have been met.
Confirm that transport time will be 3 hours or less. The ground ambulances carry Mcylinders with a capacity of 3455 liters of oxygen when fully pressurized. At 15L/min oxygen flow rate, this allows for 230min or 3 hours 50min of oxygen flow.
The wall oxygen flow meters can accurately measure to a flow rate of 15L within the ambulance. Above this, the measurements are inaccurate, possibly leading to significantly faster M-tank depletion
A buffer needs to occur to account for unforeseen issues with transfer, which is why the transport is limited to 3 hours at max of 15L/min of oxygen delivery • 2 D-cylinders (700L each) are available as backup oxygen supply in case of need. This should not be planned for as part of the overall oxygen supply, but as a backup.

Confirm that above parameters have been met
Prior to performing the interfacility transfer, ensure a fully pressurized M-cylinder tank is replaced into the ground ambulance as well as D-cylinders
Follow the operational SOP for HFNC/AIRVO

Adopted	Next Review Scheduled	Owner	Reviewer
May 2021	Mar 2023	Clinical Hub Mnager	BCEHS OHS Team