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

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