AARC Safe and Effective Staffing Guide Recognizes High Velocity Therapy as NIV

The AARC released their Safe and Effective Staffing Guide (previous known as the AARC Uniform Reporting Manual (URM)), the association’s official productivity guide with time standards for most Respiratory Care Department procedures. The time standards are based on 2020 survey results from hundreds of US Respiratory Care Department Directors and Managers.

In the new guide,  high velocity nasal insufflation (HVNI)—an advanced form of high flow—is included in the NIV section, with the same productivity time standards as that of Bi-level and CPAP. The update is consistent with the FDA QAV Product Code and the FDA Ventilator Enforcement Policy (pages 5 and 6) that recognize HVNI as a form of ventilatory support.  The Vapotherm Precision Flow Hi-VNI® is the only high flow product with the FDA QAV product designation. HVNI also is the only high flow therapy modality included in the AARC Safe and Effective Staffing Guide NIV section. Other high flow therapy modalities are under Heated Humidified High-Flow Nasal Cannula in the Supplemental Oxygen Therapy section of the guide. 

Below are the NIV procedures and corresponding activities in the AARC Safe and Effective Staffing Guide.

01.5100 Non-emergent Non-Invasive Ventilation (NIV) (CPAP, Bi-level or HVNI)

Activity IDActivity Title
01.5110Initiation of Non-emergent NIV
01.5120Patient/System Assessment of Non-emergent NIV
01.5130Setting or Device Adjustment of Non-emergent NIV
01.5140Generation of Non-emergent NIV Patient Compliance Study

01.5200 Emergent Non-Invasive Ventilation (NIV) (CPAP, Bi-level or High Velocity Nasal Insufflation Device (HFNI))

Activity IDActivity Title
01.5210Initiation of Emergent NIV
01.5220Patient/System Assessment of Emergent NIV
01.5230Setting or Device Adjustment of Non-emergent NIV
01.5240Equipment Change (All NIV)

The update provides an important reference for those Respiratory Departments that have been using HVNI as an alternative to NiPPV for respiratory distress, but have met administrative resistance to receiving the same productivity for the modalities.

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