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Headbox Oxygen Set-up

• Introduction
• Equipment
• Procedure
• Complications
• Cleaning of Equipment

• Areas of uncertainty in clinical practice

Introduction

The headbox is a clear plastic hood that surrounds the baby’s head, and has an opening for the baby’s neck, which leaves the body accessible for nursing care. The headbox maintains a stable concentration of warm and humidified oxygen that is titrated to achieve the desired oxygen saturation.

Equipment

• oxygen blender/oxygen & air flow meters with nipples
• green oxygen tubing
• humidifier base, water chamber & sterile water for irrigation
• heater hose/corrugated tubing
• headbox (with sponge, optional)
• headbox thermometer
• oxygen analyser

Procedure

• assemble the humidifier base and water filled chamber
• connect the oxygen tubing from the oxygen blender to the water filled chamber. Alternatively connect tubing from oxygen and air flow meters via a "Y" connector and then attach the single piece of tubing from the "Y" connector to the water filled chamber
• connect the heater hose to the water filled chamber
• secure the headbox thermometer to the inside of the headbox. If possible, insert spnge over gas inlet
• place the headbox over the baby’s head, taking care when positioning the headbox around the baby’s neck
• connect the heater hose to the headbox
• blend the oxygen to obtain the necessary oxygen concentration to achieve the desired oxygen saturation. The total flow of gases should be at least 6 to 8 L/min to prevent accumulation of carbon dioxide in the headbox
• desired oxygen concentrations are achieved either via a blender "dialled" to the appropriate concentration, or by combining the flow of oxygen and air using the following guide

Headbox oxygen/air flow rates

• calibrate oxygen analyser and place into the headbox, alongside the baby’s nose
• maintain the inspired gas temperature at the appropriate neutral thermal environment for the baby

Continuously assess and document hourly the following

• inspired oxygen concentration
• oxygen saturation (ﾽ hourly)
• heart rate
• respiratory rate and effort
• headbox temperature
• water level in chamber
• humidification (dry or moist)

• observe the baby’s neck for irritation and pressure areas hourly, and ensure the position of the headbox is correct
• remove any accumulated water in the heater hose hourly
• calibrate the oxygen analyser every eight hours
• check the baby’s temperature hourly for four hours or until stable when headbox oxygen commences and then four hourly

Complications

• hypoxaemia
• hyperoxaemia
• hypothermia
• hyperthermia
• irritation and pressure to neck

Cleaning of Equipment 

• change the headbox circuit, humidifying chamber and headbox when the 2 litre bag of water is empty
• the heater/humidifier is wiped clean with disinfectant
• the headbox and thermometer are washed with detergent and rinsed thoroughly
• the heater hose/corrugated tubing is pasteurized and the green oxygen tubing is discarded.

Areas of uncertainty in clinical practice

When to transfer an infant from incubator or intra-nasal flow oxygen will depend on

• the clinical situation
• the concentration of oxygen required
• the operational characteristics of the incubator being used.

As a general guide infants requiring 40% oxygen or more will usually be managed with headbox oxygen.

Optimally oxygen delivered by headbox should be warmed and humidified, however, during the immediate stabilisation of a sick infant consistency of oxygenation remains the priority.

References

Aloan, C.A. & Hill, T.V. (1997). Respiratory care of the newborn and child (2^nd ed). Philadelphia: Lippincott.

Askin, D.F. (1997). Acute respiratory care of the neonate: A self study course (2^nd ed). Petaluma: NICU INK.

Barnhart, S.L. and Czervinske (1995). Perinatal and pediatric respiratory care. Philadelphia: W.B. Saunders.

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