SELF-ADMINISTRATION VS. ASSIST TO SELF-ADMINISTRATION
WARNING:
Encourage patient to self-administer. Self-administration is a safety feature of the
demand flow Nitronox in that, if for any reason the patient becomes over sedated, the patient will
be unable to successfully hold the mask in a tight seal position on the face. The result will be that
the mask falls away from the face and the demand flow will cease, allowing the patient to breathe
room air in through the mouth or nose.
WARNING:
If a patient is unable to fully self-administer, and the medical professional provides
an assist to placement of the mask in a sealing position on the face, maintain patient observation
to prevent over sedation under any conditions. Discontinue the assistance in mask placement
immediately upon any observation of over sedation; remove the mask from the face entirely.
Never use a mask strap to hold the mask to the face. Never force the mask on the face; the
patient must always be spontaneously breathing.
At the determination of a medical professional, as an added precaution for procedures where an
assist to self-administration is used, the medical establishment may elect to continuously sample
the mixture delivery downstream from the demand valve by installation of an oxygen analyzer.
Self-administration for pediatric patients
Some establishments have developed specific protocols instructing the provider to
administer (“assisted-mask application” of Nitronox) nitrous oxide to pediatric patients,
typically ages 1 to 4. The concept that, for certain circumstances, the use of the Nitronox,
or the use of other demand valve delivery systems, should have a protocol where the
provider administers the nitrous oxide, as opposed to complete self-administration, is in
potential conflict with protocols for labor analgesia, where there is an emphasis on self-
administration. It is the responsibility of the medical establishment and the medical
professional to develop and establish specific delivery protocols.
Self-administration for laboring women
Establishments that have developed specific protocols for laboring women often include a
particular emphasis on self-administration and education for the laboring woman and for
her support persons on the techniques of self-administration. In these specific protocols,
the establishments have concluded that nitrous oxide can only safely be self-administered
by the laboring woman; with support persons needing to be educated that they absolutely
cannot assist in the delivery of nitrous oxide by holding the mask up to the laboring
woman’s face, since an integral safety feature of nitrous oxide use is that when the woman
has physiologically reached her limit of nitrous oxide intake, she will no longer be able to
hold the mask up to her face for more, thus self-regulating the intake. The establishments
have concluded that when someone else is allowed to hold the mask up to her face, the
potential risk of losing consciousness increases dramatically. Thus, there is an initial and
repetitive education for the laboring women and support persons.
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