Risks Associated With Conventional Humidifiers Adapted for High-Flow Nasal Cannula Therapy in Human Infants: Results of a Time and Motion Study

Robert Tero, Joan Cecich, Omayra Sanabria, Shyan Sun, Jose Batista, Sara Stout, Danielle Zatt, Robert Spoula, Joan Gustafson, Sook Hee Lee, Thomas L. Miller

Abstract


Background: High-flow nasal cannula (HFNC) therapy was introduced into neonatology with novel heating-humidification technology; however, the therapy is currently being applied with adapted conventional humidifiers. Managing the rainout from these adapted systems is labor intensive and may be associated with water aspiration. A time and motion study was designed to evaluate the workflow needs and operational costs between a dedicated, integrated HFNC platform (Vapotherm Precision Flow; VT) and adapted conventional humidifier technology (Fisher & Paykel MR850; FP).

Methods: Workflow was evaluated on HFNC devices in routine use. Observations were over 8 hours and staff self-reported device interactions. Workflow parameters included clearing condensate, need for suctioning, interface/tubing changes and charting. Device-related events that impacted workflow included the incidence of water in the airway, irritation and clinical sequelae. Data are reported as the mean number of contacts per device in an 8-hour shift.

Results: A total of 48 FP observations and 61 VT observations were collected across three sites. FP showed more therapist interventions (4.5 ± 1.5 vs. 1.5 ± 0.6; P < 0.001), and total unscheduled interventions (1.1 ± 1.6 vs. 0.3 ± 0.7; P < 0.001) compared to VT. Of the interventions, FP required draining tubing 2.1 ± 1.0 times vs. 0 ± 0 with VT (P < 0.001). Rainout aspiration from the FP was associated with the 0.7 ± 1.5 device-related clinical events, versus 0 ± 0 events seen with VT (P < 0.001).

Conclusions: HFNC using FP was associated with greater staff workload and patient risk related to the management of the rainout compared with VT. Thus, there may be an unaccounted cost beyond circuit price with the use of conventional technologies for the administration of HFNC.




Int J Clin Pediatr. 2014;3(4):99-104
doi: http://dx.doi.org/10.14740/ijcp172w


Keywords


High flow therapy; High-flow nasal cannula; Time and motion; Cost of care; Neonatology; Non-invasive respiratory care

Full Text: HTML PDF
 
Home     |     Log In     |      About     |      Search     |      Current     |      Archives     |      Submit      |     Subscribe


 

     

Aims and Scope

Current Issues

Conflict of Interest

About Publisher

Editorial Board

Archives

Copyright

Company Profile

Editorial Office

Misconduct and Retraction

Permissions

Company Registration

Contact Us

Abstracting and Indexing

ICMJE

Ownership

Instructions to Authors

Access

Declaration of Helsinki

Contact Publisher

Submission Checklist

Reprints

Terms of Use

Company Address

Submit a Manuscript

Open Access Policy

Privacy Policy

Browse Journals

Publishing Fee

Publishing Policy

Disclaimer

Recent Highlights

Peer-Review Process

Publishing Quality

Code of Ethics

Advertising Policy

Manuscript Tracking

Advanced Search

For Librarians

Careers

Publishing Process

Publication Frequency

For Reviewers

Propose a New Journal

       
       

International Journal of Clinical Pediatrics, quarterly, ISSN 1927-1255 (print), 1927-1263 (online), published by Elmer Press Inc.        
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.theijcp.org   editorial contact: editor@theijcp.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.

DECLARATION: THIS JOURNAL SITE OUTLOOK IS DESIGNED BY THE PUBLISHER AND COPYRIGHT PROTECTED. DO NOT COPY!