Understanding Noninvasive Ventilation

Nancy M. Steffan, PhD, RN, CRNP, CCRN


Am Nurs Journal. 2021;16(4) 

In This Article

Nursing Implications

When caring for patients receiving NIV, nurses are critical to safe use, assessment, equipment set up, and patient-centered care.


Oxygen is a drug, so a provider's order will be required; hospital policy may govern standing orders and protocols for initiating supplemental oxygen. Although oxygen is generally safe and effective, it has the potential for adverse effects if used incorrectly. The American Thoracic Society reports several hazards associated with oxygen therapy, including nasal dryness and irritation, fire risk, oxygen toxicity, and breathing suppression.

Because oxygen supports combustion, tanks should be kept away from open heat sources, including heating vents and petroleum-based personal care products. High oxygen concentrations (>60% FiO2) over 24 hours can lead to oxygen toxicity and possible permanent cellular damage. In patients with chronic hypercapnia, oxygen therapy can suppress the patient's stimulus to breathe, increasing carbon dioxide retention and leading to acute respiratory failure. Therefore, oxygen therapy administered at the lowest effective dose is recommended.


In addition to the seven rights of medication administration, delivering supplemental oxygen must include these verifications: right physiologic criteria, right equipment, and right environment. Regardless of a patient's disease process, they must be able to breathe on their own and protect their own airway to receive NIV. The right equipment and interface are imperative to optimize safe and efficient oxygen delivery and ensure a good fit. Typically, NIV with FiO2 rates greater than 50% are limited to high-acuity settings such as intensive care or progressive care units.

Perform a cardiopulmonary assessment that includes evaluating baseline oxygen saturation values and assessing arterial blood gases. In addition, assess nostril patency and look for signs of hypoxia (changes in level of consciousness, tachycardia, arrhythmia, restlessness, somnolence, changes in respiratory rate and blood pressure, clammy skin, and mottling). Assess these parameters as part of monitoring response to therapy as well.

Equipment set up

After the equipment is assembled, check the connections, turn on the oxygen source, verify the flow rate with the order, and ensure the oxygen is flowing. When applying a nasal cannula, direct the curved prongs inward and hook the tubing behind the patient's ears and under the chin. When applying a face mask, place it over the patient's nose, mouth, and chin; then press the flexible metal edge to fit the patient's nose.

Patient-centered Care

Nurses can take several steps to ensure patients remain at the center of care efforts, including providing education and reassurance to decrease patient and family anxiety, facilitate comfort, and improve adherence. (See Patient-centered care.)