Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed. Obtain a medical history.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [129], C).

   To reduce patient anxiety (RCA [149], C).

   To ensure the patient has no underlying medical problems that contraindicate the use of Entonox (BOC Healthcare [18], C).
2. 2.Show
   Turn on the Entonox supply from the cylinder.
   To ascertain whether there is any Entonox in the cylinder. E
3. 3.Show
   Examine the gauge to determine how much gas is in the cylinder.
   To ensure an adequate supply of gas throughout the procedure (BOC Healthcare [17], C).
4. 4.Show
   Ensure that the patient is in as comfortable a position as possible.
   To promote patient comfort. P
5. 5.Show
   Demonstrate how to use the apparatus by holding the mask or mouthpiece to your own face or mouth (replace the mask or mouth piece before handing the equipment to the patient). Explain to the patient that they should breathe in and out regularly and deeply. Advise them that a hissing sound will be heard, indicating that the gas is being inhaled.
   To ensure that the patient understands what to do and what to expect. E
6. 6.Show
   Allow the patient to practise using the apparatus (with the gas turned on).
   To enable the patient to adopt the correct technique (BOC Healthcare [17], C).

Procedure

1. 7.Show
   Encourage the patient to breathe gas in and out for at least 2–3 minutes, as this is the time it takes for the analgesic effect to take place (BOC Healthcare [17]). If the gas is being used before a painful procedure, allow the patient to breathe the gas in for about 2 minutes before starting (BOC Healthcare [17]).
   To allow sufficient time for an adequate circulatory level of nitrous oxide to provide analgesia. When the patient inhales, gas first enters the lungs and then the pulmonary and systemic circulations. It takes 2–3 minutes to build up reasonable concentrations of nitrous oxide in the brain (BOC Healthcare [18], C).
2. 8.Show
   While they are using Entonox, encourage the patient to breathe in and out regularly and deeply.
   To maintain adequate circulatory levels, thus providing adequate analgesia (BOC Healthcare [18], C).
3. 9.Show
   Evaluate the effectiveness of the Entonox by verbally questioning the patient and/or conducting a pain assessment, and encouraging the patient to self‐assess the analgesic effect. This should then be documented.
   To establish whether the Entonox has been a useful analgesic. E

Post‐procedure

1. 10.Show
   Turn off the Entonox supply from the cylinder.
   To avoid potential seepage of gas from the apparatus (BOC Healthcare [19], C).
2. 11.Show
   Depress the diaphragm under the demand valve.
   To remove residual gas from the tubing (BOC Healthcare [17], C).
3. 12.Show
   Follow local policies and guidelines for the cleaning and sterilization of expiratory valves and tubing, and face‐masks (or dispose of the equipment if it is single use). Filters and mouthpieces should be discarded after use.
   To reduce the risk of cross‐infection (BOC Healthcare [16], C).
4. 13.Show
   At the end of the procedure, observe the patient for up to 30 minutes until the gases have worn off.
   Some patients may feel transient drowsiness or giddiness and should be discouraged from getting out of bed until these effects have worn off (BOC Healthcare [19], C). Adverse psychometric effects will normally cease shortly after the administration of Entonox has stopped due to the rapid elimination of the nitrous oxide component of the medical gas mixture from the body (BOC Healthcare [16], C).
5. 14.Show
   Record the administration on the appropriate documentation.
   To promote continuity of care, maintain accurate records and provide a point of reference in the event of any queries (NMC [129], C).