Pre‐procedure

ActionRationale

1. 1.Show
   Explain and discuss the procedure with the patient and perform hand‐washing technique at bedside.
   To ensure that the patient understands the procedure and gives their valid consent (NMC [159], C).

   To reduce patient anxiety (Royal College of Anaesthetists [195], C).

   To ensure the patient has no underlying medical problems that contraindicate the use of Entonox (BOC [19], C).

Procedure

1. 2.Show
   Ensure that the patient is in as comfortable a position as possible.
   To promote patient comfort (BOC [18], C).
2. 3.Show
   Turn on the Entonox supply from the cylinder.
   To ascertain whether there is any Entonox in the cylinder (BOC [18], C).
3. 4.Show
   Examine the gauge to determine how much gas is in the cylinder.
   To ensure an adequate supply of gas throughout the procedure (BOC [18], C).
4. 5.Show
   Demonstrate how to use the apparatus by holding the mask tightly to your face, replacing the mask/mouthpiece that you have used (ensure that the Entonox is turned off at this point). Explain to the patient that when they breathe in and out regularly and deeply, 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 before any painful procedure commences (BOC [18], C).
5. 6.Show
   Allow the patient to practise using the apparatus.
   To enable the patient to adopt the correct technique and for the nurse to observe the analgesic effect of the gas before the procedure commences (BOC [18], C).
6. 7.Show
   Encourage the patient to breathe gas in and out for at least 2 minutes before commencing any painful procedure.
   To allow sufficient time for an adequate circulatory level of nitrous oxide to provide analgesia. When the patient inhales, gas enters first the lungs then the pulmonary and systemic circulations. It takes 1–2 minutes to build up reasonable concentrations of nitrous oxide in the brain (BOC [18], C).
7. 8.Show
   During the procedure, encourage the patient to breathe in and out regularly and deeply.
   To maintain adequate circulatory levels, thus providing adequate analgesia (BOC [18], C).
8. 9.Show
   Evaluate the effectiveness of Entonox with the patient throughout and following the procedure, by verbal questioning and encouraging the patient to self‐assess the analgesic effect.
   To establish whether the Entonox has been a useful analgesic for the procedure. This should then be documented to assist any subsequent procedures, for example dressing changes (BOC [18], C).
9. 10.Show
   At the end of the procedure observe the patient every 5–10 minutes until the effects of the gas have worn off. Observe the patient for up to 30 minutes.
   Some patients may feel a transient drowsiness or giddiness and should be discouraged from getting out of bed until these effects have worn off. It is rare for the patient to experience transient amnesia (BOC [18], C).

Post‐procedure

1. 11.Show
   Turn off the Entonox supply from the cylinder.
   To avoid potential seepage of gas from the apparatus (BOC [18], C).
2. 12.Show
   Depress the diaphragm under the demand valve.
   To remove residual gas from tubing (BOC [18], C).
3. 13.Show
   Follow local policies/guidelines for the cleaning and sterilization of expiratory valve and tubing, and facemask (or disposal if single use). Filters and mouthpieces should be discarded after use.
   To reduce the risk of cross‐infection (BOC [18], C).
4. 14.Show
   Record the administration on appropriate documentation.
   To promote continuity of care, maintain accurate records and provide a point of reference in the event of any queries (BOC [18], C; NMC [158], C).