# Nasal Cannula



## ThadeusJ (Jun 20, 2013)

Had an interesting discussion about the preferred style of "nose hose" aka nasal cannula.  

There are a million shapes and style out there and most often they are purchased based on price.  If you had the choice, what's your preference: straight, curved, flared/non-flared, long...

No one usually cares until they get a set that they can't stand...so what are your preferences?


----------



## Arovetli (Jun 20, 2013)

I didn't know anyone cared that much tiny plastic tips that rest up in a stranger's snout.


Interested to hear from those who do....


----------



## MMiz (Jun 20, 2013)

It was never an issue in the pre-hospital setting. Patients were never on O2 long enough to care. 

IFT, discharges, and dialysis patients were more picky about their nasal cannulas, though I never noticed a style patients preferred.


----------



## JPINFV (Jun 20, 2013)

The cheapest one available.


----------



## Jim37F (Jun 20, 2013)

I've always heard "nose hose" as an NPA, not a cannula...


----------



## MMiz (Jun 20, 2013)

Jim37F said:


> I've always heard "nose hose" as an NPA, not a cannula...


Oops, my bad. You're right, I think this thread is about NPAs.


----------



## Anjel (Jun 20, 2013)

ThadeusJ said:


> Had an interesting discussion about the preferred style of "nose hose" aka nasal cannula.



Pretty sure it's about nasal cannulas.


----------



## Medic Tim (Jun 20, 2013)

The 911 service I wotk pt for just got new ones. They are super short and are stiff so they like to coil and get in the way. kind of annoying but manageable.


----------



## VFlutter (Jun 20, 2013)

HHFNC @ 60lpm :blink:


But for real it works wonders on hypoxemic distress and non-compliment BiPAP patients.


----------



## Rialaigh (Jun 20, 2013)

The ones with the longest tube length


----------



## JPINFV (Jun 20, 2013)

Rialaigh said:


> The ones with the longest tube length



#ThatsWhatSheSaid


----------



## abckidsmom (Jun 21, 2013)

We recently got a shipment of cannula a with elastic bands that go around the patients head. Those suck. That ends my real strong opinion base about nasal cannulae. 

Which are not nose hoses.  that's an NPA.


----------



## ThadeusJ (Jun 21, 2013)

Thanks for the feedback and yes, I meant nasal cannula.

As I mentioned in the initial inquiry, most people don't care until there's an issue and then they're cranky.  Although it hard to screw up cannula, someone, somewhere will find a way...I never thought about elastic straps..._someone_ thought it was a good idea...


----------



## Anjel (Jun 21, 2013)

I prefer this one


----------



## Clipper1 (Jun 21, 2013)

ThadeusJ said:


> Although it hard to screw up cannula, someone, somewhere will find a way...I never thought about elastic straps..._someone_ thought it was a good idea...



Those with the elastic straps may not cause as much damage around the ear as easily as those which loop plastic around them. Sometimes even two hours with the NC on can mean the start of skin break down which then will have to be reported.  

In EMS for the short time, rarely is it an issue. But, if your NC is one of the stiffer types, these may need to be changed quickly to something more comfortable and less chance of skin breakdown once in the hospital. But then again that is not something you will need to be concerned about.


----------



## Clipper1 (Jun 21, 2013)

Anjel said:


> I prefer this one



That one is excellent but at $10 each it might not be the best for EMS.  Many of our home care patients use this for comfort when awake (difficult to sleep with if a side sleeper) and it doesn't look like a nasal cannula at first glance in public. It is also capable of higher flows which might be needed in home care for those with pulmonary HTN, fibrosis and end stage COPD.  

The Oxymizer is also great but expensive although worth every penny in home health or nursing homes which do not have piped in O2.


----------



## NomadicMedic (Jun 21, 2013)

NC with ETCO2. 
"Anything else is just oxygen!"™


----------



## Clipper1 (Jun 21, 2013)

DEmedic said:


> NC with ETCO2.
> "Anything else is just oxygen!"™



Are all BLS trucks now able to monitor ETCO2?  If not then it might not be cost effective to purchase something which is more expensive.


----------



## Anjel (Jun 21, 2013)

Clipper1 said:


> Are all BLS trucks now able to monitor ETCO2?  If not then it might not be cost effective to purchase something which is more expensive.



If you have no BLS trucks at your company, and encourage ETCO2 monitoring for any patient requiring oxygen. Than this seems to make perfect sense. Kill 2 burns with one stone.


----------



## STXmedic (Jun 21, 2013)

Clipper1 said:


> Are all BLS trucks now able to monitor ETCO2?  If not then it might not be cost effective to purchase something which is more expensive.


----------



## Clipper1 (Jun 21, 2013)

PoeticInjustice said:


>



I guess you think that is a silly question. Isn't Scope of Practice always in debate here and aren't some EMTs now AEMTs?

You  should not just take at face value that all systems are the same.  Some BLS trucks do carry extra ETCO2 cannulas since they also transport flight and CCT crews.

Aren't you also one of those who is always saying no one knows what EMS does? Now when you get a chance to differentiate between what your BLS trucks are capable of and can provide, you post some silly photo which is kinda insulting to EMTs who might be on trucks with crews capable of doing more than you. 

As ALS, do you do ETCO2 on all patients just for the extra charge?  A lot of home O2 patients may have other complaints and do not need ETCO2 monitoring. Do you toss their cannula and place ETCO2 just for the charge or your protocols says so?

Maybe it is time some in EMS like yourself start to think about why certain equipment is chosen. Is it financial? Contract with a certain vendor? Reimbursement? Compatibility with hospitals or other services' equipment?   Ever wonder why others in health care do give you the  Tommy Lee Jones look in the ER?


----------



## Arovetli (Jun 21, 2013)

Anjel said:


> I prefer this one



Plus your patient can pretend he is a head football coach or flying a jumbo jet.


----------



## Clipper1 (Jun 21, 2013)

Arovetli said:


> Plus your patient can pretend he is a head football coach or flying a jumbo jet.



For those just given home O2 and are still uncomfortable with being stuck with it probably for the rest of their life, that might not be a bad thing especially for kids of school age who must wear O2.


----------



## STXmedic (Jun 21, 2013)

Clipper1 said:


> I guess you think that is a silly question. Isn't Scope of Practice always in debate here and aren't some EMTs now AEMTs?
> 
> You  should not just take at face value that all systems are the same.  Some BLS trucks do carry extra ETCO2 cannulas since they also transport flight and CCT crews.
> 
> ...



You make a lot of assumptions, don't you? You should really work on that. Especially since most of your assumptions are completely asinine, off-base, and unfounded. 

Where did anybody discuss scope of practice?

Where did I say all systems were the same? 

Where have I ever said "no one knows what EMS does" or anything remotely close to that (here's a hint: the answer is never)

No I do not do EtCO2 on all patients, nor have I ever hinted that I do. 

Do you encounter many patients that understand EtCO2 and when it is and is not needed? You let patients completely dictate your care, then? If a patient WebMD's their self with cardiac chest pain, are you going to then give them Nitro, Aspirin, and Morphine because they say they need it? (You see, I can make completely erroneous assumptions, too.)

Have I given you any indication that I have zero understanding of the business aspect of EMS? I'm willing to bet it's another one of your completely unfounded assumptions that you seem so keen on pulling out of thin air.

If you're just going to take everything out of context to try and start an argument, maybe think about refraining from posting. I don't think there's a single person on this forum that would be disappointed. In fact, I think I may take a page out of Expat's book, because I am really tired of reading your incessant garbage.


----------



## JPINFV (Jun 21, 2013)

PoeticInjustice said:


> If you're just going to take everything out of context to try and start an argument,



I don't know if you realized this or not, but that's her MO.


----------



## STXmedic (Jun 21, 2013)

JPINFV said:


> I don't know if you realized this or not, but that's her MO.



Oh yes, thus the last sentence of my post.


----------



## Clipper1 (Jun 21, 2013)

PoeticInjustice said:


> Oh yes, thus the last sentence of my post.



Basically all you and jpnfv want to do is sling insults. This is your forum and you are obviously some of the leaders here.

But, what I am trying to do is to get some to consider why a company makes the choices it does for equipment. It is not always because of the glossy ads in magazines or whatever is most popular at the time. It may not even be about patient care.

I asked a few simple questions to clarify  Poet's post. This is how you also need to approach making any purchasing decision.  You must know the needs of your service including the types of patients, the vendors your company associates with and the budget.   

If you want to insult and ramble on nonsense by nitpicking and posting juvenile photos, you can. This is your website and luckily it does say *EMT*life. Maybe closing this website so it is not a public site might keep others from trying to educate you on certain processes involving both the business and patient care side.


----------



## abckidsmom (Jun 21, 2013)

Simmer down. Discussion of perceived insults in this thread ends now. 

Feel free to continue with a NICE discussion of types of nasal cannulae.


----------



## NomadicMedic (Jun 22, 2013)

Clipper, the only leaders here are the people with their name in red. (The community leaders) However, we do have some strong personalities here and you need to be ready to take some heat when you post items that others may question. 

As far as the ETCO2 cannula, our service is exclusively ALS. These cannula are not made available to BLS unless a paramedic is on scene and places one. In cases where I provide sedation or pain management or have a patient that I need to monitor the ventilatory status of, I use an ETCO2 filter set. In fact, if a patient requires oxygen from me, they'll get a filter set, as I don't provide oxygen "just in case". The filter sets are more expensive than a simple NC, but provide additional data I can use when assessing and treating my patients. 

I hope that helps clarify my use of a ETCO2 filter set.


----------



## ZombieEMT (Jun 22, 2013)

My volunteer department uses what ever nasal cannula the hospital is currently using. We have an agreement with the hospital to purchase our supplies through the hospital systems. We are getting them for a significantly cheaper price then buying through the supplies. The only issue we seem to have, is that we do not have a choice with what to use.

I know one thing that differs between my two departments is adult and pediatric. In my volunteer department we carry both. On the paid department we only carry an adult. The size difference is so minimal and we use them so infrequently that pediatric are not needed (or required by state).


----------



## rmabrey (Jun 22, 2013)

As long as they aren't tangled when I own the plastic I don't care


----------

