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Introduction Blood gas monitoring is crucial in patients on acute non-invasive ventilation (NIV) for acute hypercapnic respiratory failure (AHRF). Performing an arterial blood gas (ABG) sampling demands an experienced doctor or a specialist nurse. Capillary blood gas (CBG) can be done by any nursing staff or physiologist with appropriate training, with similar efficacy to monitor the pH and PaCO2.Aim To evaluate the feasibility, patient experience, and effectiveness of CBG monitoring compared to ABG in AHRF patients requiring acute NIV.Method Data were collected in two phases. Initially, three months retrospective data collected from June to August 2024 of patients who received acute NIV for AHRF in the Respiratory Support Unit (RSU) to understand the median duration on acute NIV and the average number of ABG done during inpatient. Then, as a pilot project, three advanced nurse practitioners were trained to do CBG for blood gas monitoring after 24 hours of acute NIV initiation. We collected one-month prospective data on CBG-guided NIV support and patients’ pain score using the visual analogue scale with a questionnaire.Result Total 60 patients’ data were analysed retrospectively. The mean age was 67 years. Affected males and females were 33 and 27, respectively. Median duration on acute NIV was 4 days. The average number of ABG done during admission was 12 per patient. In the prospective study, we provided a questionnaire to total15 patients to get the patient reported experience. 80% (13) patients described ABG as ‘severe to worst possible pain’ and 100% (15) patient described CBG as ‘no pain to mild pain’. All patients preferred CBG as a method for blood gas sampling. No observable difference identified in CBG-guided NIV support in contrast to ABG.Conclusion CBG monitoring aligns with BTS NIV and RSU standards by meeting the core recommendations for frequent blood gas assessment and continuous patient monitoring and review. As a less invasive alternative to ABG, CBG offers a patient-centred approach that minimizes discomfort. Our gradual introduction of CBG monitoring into the unit has led to significant improvements in patient comfort without compromising the clinical rigor required for effective NIV management.