Cardio Respiratory Monitoring —
Training activity: 4

Details

Prepare for use various types of oxygen therapy from basic oxygen mask to high flow and continuous positive airway pressure (CPAP), including any monitoring equipment needed

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Equipment set up and pre-use check
• Preparation of area
• Patient centred care and support
• Communication with patients, relatives and the clinical team
• Connection to patient
• Contraindications
• Troubleshooting
• Risk management
• Drug prescriptions
• Infection control

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to accurately setting up and preparing various types of oxygen therapy (basic mask, high flow, CPAP) and associated monitoring equipment for use.
• Consider how the learning outcomes apply, specifically in relation to maintaining patient respiratory function, effective communication, and practicing safely by managing the risk of equipment failure or infection.
• Discuss with your training officer to gain clarity of what is expected of you in relation to preparation steps, required monitoring checks (e.g., humidification setup, FIO₂ monitoring), and ensuring circuit integrity for different delivery types.

What is your prior experience of this activity?

• Think about what you already know about setting up and preparing basic oxygen masks, high flow nasal cannula, and CPAP circuits.
• Consider possible challenges you might face during the activity, such as troubleshooting equipment compatibility between the oxygen source and delivery device or ensuring that the CPAP circuit maintains a seal and identifying leaks.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if you encounter a persistent issue with setting the high flow nasal cannula parameters or if the required specific brand of monitoring equipment is unavailable.
• Acknowledge how you feel about embarking on this training activity, particularly your familiarity with the operational steps for the different types of equipment.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as efficiently assembling equipment, checking circuit integrity for high flow and CPAP systems, and accurately setting up required monitoring equipment, drawing upon previous experiences.
• Identify the specific insights you hope to gain into the practical differences in preparing equipment for various oxygen delivery methods and the critical importance of components like humidifiers for high-flow systems.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of oxygen therapy setup or similar respiratory equipment.
• Identify important information you need to consider before embarking on the activity, such as reviewing the academic content on oxygen therapy techniques and its risks, or institutional protocols for electrical and infection control when setting up CPAP devices.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst setting up the required oxygen therapy (e.g., High Flow or CPAP) or preparing the monitoring equipment?
• Are you encountering situations such as:
  • Technical issues arise with equipment connection or power supply for the high-flow humidifier or the CPAP machine, compromising readiness?
  • A colleague asks a detailed question about monitoring parameters (e.g., PEEP settings or FiO₂ targets) that requires immediate clarification beyond routine setup?
  • Unexpected difficulty arises in setting up the circuit integrity for CPAP delivery, resulting in significant leaks or monitoring failure?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to equipment assembly, safety checks, or explaining the device function?
• Consider the steps you are taking in the moment, such as:
  • Immediately pausing the assembly to retrieve the equipment manual or consult the departmental checklist to troubleshoot a component failure
  • Adapting your communication style to simplify technical monitoring concepts for a colleague or patient who is struggling to understand the required compliance
• How are you feeling in that moment? For instance, are you finding it difficult to resolve complex equipment failure quickly? Is it affecting your confidence in maintaining patient safety protocols during preparation?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully resolving minor technical difficulties and ensuring the equipment is safely operational? Or are you needing support because major equipment malfunction or the complexity of required monitoring adaptation necessitates senior technical or clinical input?
• What are you learning as a result of the unexpected development? For example, are you mastering a more robust checklist for CPAP circuit integrity? Or gaining insight into the physiological consequences of equipment failure during high-flow delivery?

On action

What happened?

• Begin by summarising the key steps you took when preparing the various types of oxygen therapy equipment, from basic masks to high flow and CPAP, including any necessary monitoring equipment.
• Consider specific events, actions, or interactions which felt important, such as how you resolved a connection issue with the high-flow humidification unit or ensured the CPAP circuit integrity.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately stopping the assembly to reference the equipment manual when a component appeared unfamiliar.
• How did you feel during this experience, e.g., did you feel focused on maintaining technical precision or stressed by the requirement for speedy preparation?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding preparing oxygen therapy and monitoring equipment. What strengths did you demonstrate, e.g., meticulous checking of the CPAP pressure relief valves?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the setup protocols for a specific brand of high-flow nasal cannula?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in ensuring patient safety during preparation?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the acceptable range for FiO₂ monitoring calibration, and how you reacted to this.
• Acknowledge any changes in your own feelings now that you are looking back on the experience.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to streamlining the safety checklist for setting up CPAP systems.
• What will you do differently next time you approach preparing oxygen therapy equipment, for instance, by proactively confirming the availability of all required consumables (e.g., sterile water for humidification) before starting the setup?
• Do you need to practise any aspect of the activity further, such as troubleshooting common faults in high-flow circuits or key learning outcomes related to applying techniques to maintain patient respiratory function?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of setting up high-flow or CPAP in high-stakes, real-time clinical scenarios since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, a persistent leak compromising ventilation on a subsequent CPAP setup for acute respiratory distress forced you to re-evaluate the meticulousness of your circuit sealing technique during your first attempt at this training activity.
• Considering what you understand about infection control and circuit integrity now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your equipment preparation checklist and humidification protocols based on further learning and experiences? For example, how you proactively implemented the use of specialised tubing hangers to prevent water condensation (rainout) in high-flow circuits based on further learning and equipment reviews.
• Has discussing unresolved humidification issues or the impact of poor circuit preparation on patient respiratory comfort with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior respiratory therapist about a severe failure of oxygen delivery due to an unchecked equipment connection refined your understanding of the critical nature of meticulous safety checks.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent experiences preparing respiratory support equipment, contributed to your overall confidence and ability in safely and efficiently preparing diverse oxygen delivery systems (e.g., CPAP and high-flow), particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated meticulousness in checking circuit integrity and component assembly now enables you to confidently set up respiratory support equipment during a relevant DOPS assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to equipment setup and technical safety checks for oxygen therapy? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or Technical Specialist immediately when a major equipment malfunction (e.g., CPAP machine failure or unresolvable pressure leak) is detected, recognising this requires specialist technical input beyond routine setup scope.
• Looking holistically at your training journey, how has this initial oxygen therapy preparation experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying techniques to maintain patient respiratory function and practising safely? For example, how this foundational experience has supported your development in understanding and managing the critical safety requirements for complex respiratory monitoring and therapeutic equipment.

Relevant learning outcomes

#	Outcome
# 2	Outcome Apply techniques to maintain patient respiratory function.
# 5	Outcome Communicate effectively with the patient and the multi-disciplinary team.
# 6	Outcome Practice safely, managing risk in all elements of patient care.