Development of Nitronox Delivery Protocols
It is the responsibility of the medical establishment and the medical professional to develop and
establish specific delivery protocols.
The Nitronox® Inhalation Analgesia System is designed to deliver a fixed concentration of 50%
nitrous oxide and 50% oxygen on the demand flow [self-administration] principle. The medical
professional will turn on and observe the operating indicators of the device. In order to receive the
analgesic, the patient will self-administer by holding the face mask firmly in place during the
procedure. With the face mask sealed every time the patient takes a breath, the patient inhalation
will open the demand valve and deliver the mixed gas through the face mask.
Common procedures conducted with Nitrous Oxide – Oxygen Sedation include:
General Pain Management, Labor and Delivery, Wound Debridement, Fracture Reduction,
Catheter Insertion, Foreign Object Removal, Setting Broken Bones / Lacerations, Botulinium
Injection, Barium Enema, Joint Injections, Gastrostomy, Sutures, IV Starts, CT Scans.
The Nitronox Inhalation Analgesia System is considered transient (less than 60 minutes) in terms
of continuous use when providing Analgesia (pain management), Minimal Sedation or Moderate
Sedation. However, a procedure or medical condition that occurs over the course of many hours,
also is considered to be using transient delivery, in that, given self-administration techniques, the
patient will be unlikely to hold the face mask to the face continuously for over 60 minutes. For
example, a woman in labor may safely use Nitronox in a transient self-administration mode over
the course of several hours as secondary labor and end labor stages are experienced. The upper
limit of the number of hours of this described transient delivery is at the determination of the
medical professional.
Patient Population (Adult and Pediatric): Used to deliver a gas mixture to a conscious
spontaneously breathing patient who is awake, alert and cooperative and requires relief
from moderate to severe pain and is under the continuous supervision of a healthcare
professional. Age/Weight limitations: see Relative Contraindications (at the determination
of medical professional).
Note:
Porter recommends the use of a disposable full face mask (DEHP-free and Latex-free) that
is biocompatible for medical use. Follow manufacturer’s instructions. The disposable mask
materials have been chosen by the medical device manufacturers of the masks intended for
medical usage. Many establishment protocols also call for the use of a bacterial filter. Follow
manufacturer’s instructions.
Continuous flow vs. demand flow devices
Equipment to deliver nitrous oxide and oxygen sedation are often categorized as demand
flow or continuous flow devices. The Nitronox is a demand flow device. Different specific
delivery protocols will be established for the two categories of equipment. The differences
center around self-administration for demand flow devices vs. direct administration by
medical professionals for continuous flow devices. Also, continuous flow devices typically
allow the administration of variable concentrations of nitrous oxide and variable flow rates
of delivered mixture. However, some establishments have developed specific protocols
for delivery with continuous flow devices, where the medical professional is able to adjust
to deliver various percentage mixes, where, with supervision, the delivery could be
described as “self-administration,” in that the patient will hold the full face mask to the
face.
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