Heated high-flow humidity for tracheostomy​

At the end of this page, you will be able to:  

• understand how a heated high-flow (HHF) humidifier works.

In a heated high-flow (HHF) humidification system, for example Airvo, the air is both humidified and warmed. If necessary, your child can also receive oxygen through this humidification system.​

How does an HHF humidifier work?

This type of humidifier features a water chamber, which holds sterile or sterile distilled water. When the unit is plugged in and switched on, the water is warmed up until it evaporates and passes into a breathing tube connected to your child’s tracheostomy. Receiving warm and moistened air will thin out your child’s thick secretions and make it easier for your child to cough them up and for you to suction it out. Your child's health-care team will prescribe the settings for the Airvo unit. These include the temperature setting, the amount of flow and any oxygen to be added in to the unit.

Points to note about a heated high-flow humidifier

• The Ontario Ministry of Health does not provide funding for this type of humidifier, but it may be covered by private insurance or Ontario Disability Support Program (ODSP) if your child is put on your ODSP benefits.
• You can purchase heated high-flow units and supplies through a respiratory vendor. Maintenance services are also available through vendors.
• Clinic teams are making efforts to advocate government programs to fund this type of humidifier.

How to assemble an HHF humidifier

Before you start

Gather your equipment and supplies:

• heated high-flow (HHF) unit (e.g., Airvo)
• auto-filled water chamber OR refillable water chamber
  
• water bag
• sterile, distilled water​
• heated breathing tube
• tracheostomy interface, or an adapter with tracheostomy mask
• oximeter, if your child uses one
• gloves

Always have the following extra supplies on hand:

• extra sterile distilled water
• extra tubing
• extra tracheostomy adaptor
• gloves

Assembling the HHF humidifier

1. Wash your hands.
2. Plug the heated high-flow unit’s power cord into the main power supply.

3. 

   Slide the water chamber into the HHF unit.

4. 

   Connect the water bag (reusable or disposable). Some water chambers fill differently. You will be taught how to fill the water chamber of your humidification equipment.

5. 

   Connect one end of the heated breathing tube to the outlet of the water chamber.

6. 

   Connect the other end of the heated breathing tube to your child’s tracheostomy interface.

7. Add oxygen if prescribed.
8. Turn on the unit by pressing the On/Off button.
9. Wait until the "Ready for use" symbol (a circle and checkmark) appears. This may take a few minutes.
10. Check prescribed settings (oxygen amount, flow and temperature settings).
11. Ensure child has been suctioned before use and that oximeter is applied.

12. 

    Connect the interface to your child’s tracheostomy.

When the set up is complete, it should look like the image on the right.

Signs to watch for

• signs of discomfort
• work of breathing

IMPORTANT:

The humidifier should always sit lower than:

• your child’s head
• the level of the head of your child’s bed or crib

Other things to know:

• Never cover the tubing as this can become a fire hazard.
• Always switch off the unit and unplug from AC power source prior to cleaning.
• While Airvo is not in use, turn off oxygen flow going into the Airvo unit.
• If there is a power outage ensure you remove your child from the AIRVO device as it does not have a battery.

Changing the temperature of the water

• Change the temperature of the humidification by using the arrows on the Airvo. The temperature will depend on your health-care team’s instructions and what is comfortable for your child.
• When you turn on the Airvo, it may take a little time to warm up to the desired temperature.
• The water temperature in the chamber can change (depending on the room temperature, heaters, fans or blankets) to make sure your child’s humidification continues to be the right temperature.

How to clean and maintain an HHF humidifier

Weekly

• Disconnect the interface from the heated tubing and wash it weekly in warm water with mild dishwashing detergent and rinse in drinking-quality water
• Tracheostomy adaptor interfaces can be used for up to 30 days.
• If using Optiflow Junior Nasal Cannula, discard after a maximum of one week. Replace earlier if needed.
• Use detergent and water or a detergent wipe to thoroughly clean the outside surface of the HHF unit. Allow to dry before use.
• Wash reusable chamber (please refer to the user manual). Empty water, separate the base of unit and wash with warm soapy water. Reassemble.

Every 2 to 4 weeks

• Replace all tube and chamber kits (tubing, auto-fill water chamber and adaptor).

Every 2 months

• Replace the auto-fill water bag.

Every 3 months or 1000 hours of use

• Change the air filter. If an air filter needs to be changed, the HHF unit will indicate this on its screen.

You can get more disinfection and cleaning instructions in the HHF humidifier's user manual.