Nebulizer Therapy
An established component of respiratory care, nebulizer therapy aids bronchial hygiene by restoring and maintaining mucous blanket continuity; hydrating dried, retained secretions; promoting expectoration of secretions; humidifying inspired oxygen; and delivering medications. Therapy may be administered through nebulizers that have a large or small volume, are connected to ventilator tubing, or are ultrasonic.
Large-volume nebulizers, such as the Venturi jet, are used to provide long-term 100% humidity for an artificial airway, such as with a tracheostomy or for certain pulmonary conditions such as cystic fibrosis. (See Large-volume nebulizer.) The aerosol mist can be delivered via mist tent, hood, mouthpiece, mask, T-piece, face tent, or tracheostomy collar.
In-line nebulizers are used to deliver medications to patients who are being mechanically ventilated. In this case, the nebulizer is placed in the inspiratory side of the ventilatory circuit as close to the endotracheal (ET) tube as possible.
Ultrasonic nebulizers are electrically driven and use high-frequency vibrations to break up surface water into particles. The resultant dense mist works to penetrate smaller airways and is useful for hydrating secretions, which induces a cough and sputum. The aerosol mist can be delivered to the patient via mist tent, hood, mouthpiece, mask, T-piece, face tent, or tracheostomy collar. Some ultrasonic nebulizers can also aerosolize medications, but this delivery system hasn’t resulted in a demonstrably better clinical response to medication than a standard jet nebulizer.
Standard precautions for body fluid isolation should be used for all patients on nebulizer therapy. Special droplet precautions should be implemented for patients with known or suspected tuberculosis, including enclosing and containing aerosol administration and filtering aerosols that bypass or are exhaled by the patient.
Equipment
For Large-Volume Nebulizer Therapy
Pressurized gas source ▪ flowmeter ▪ patient interface device (such as a mask or collar) ▪ large-bore oxygen tubing ▪ nebulizer ▪ sterile distilled water ▪ heater, if ordered ▪ in-line thermometer, if using heater ▪ facial tissues and emesis basin or container for collecting or disposing of expectorated sputum ▪ suction source and supplies ▪ personal protective equipment ▪ Optional: oxygen blender (if a built-in adjustable oxygen controller isn’t available).
For Small-Volume Nebulizer Therapy
Pressurized gas source ▪ flowmeter ▪ oxygen tubing ▪ nebulizer cup ▪ mouthpiece or mask ▪ normal saline solution ▪ prescribed medication ▪ facial tissues and emesis basin or container for collecting or disposing of expectorated sputum ▪ personal protective equipment ▪ Optional: suction source and supplies.
For In-Line Nebulizer Therapy
Pressurized gas source ▪ flowmeter ▪ in-line nebulizer cup ▪ normal saline solution ▪ prescribed medication ▪ personal protective equipment.
For Ultrasonic Nebulizer Therapy
Ultrasonic gas-delivery device ▪ large-bore oxygen tubing ▪ patient interface device (such as a mask or collar) ▪ nebulizer couplet compartment ▪ facial tissues and emesis basin or container for collecting or disposing of expectorated sputum ▪ inhaled bronchodilator ▪ Optional: suction source and supplies, personal protective equipment.
Preparation of Equipment
Gather the appropriate equipment. Label all medications, medication containers, and other solutions and handle them using sterile technique.1 Discard multidose containers after 24 hours.
For in-line nebulizer therapy, draw up the medication and diluent, open the nebulizer cup, inject the medication, and then replace the lid. Attach the cup to the gas source with attached tubing.
EquipmentLarge-Volume Nebulizer
The large-volume Venturi jet nebulizer works by passing air through a Venturi opening, drawing liquid up through feeding tubes, and nebulizing the solution.
Advantages
Provides 100% humidity with cool or heated devices
Provides oxygen and aerosol therapy
Can be used for long-term therapy
Disadvantages
Increases the risk of bacterial growth (in reusable units)
Causes a collection of condensate in large-bore tubing
May cause mucosal irritation from breathing hot, dry air (if water level isn’t maintained correctly in reservoir)
Increases the risk of overhydration from mist (in infants)
For ultrasonic nebulizer therapy, fill the couplet compartment on the nebulizer to the level indicated with the solution recommended by the manufacturer (typically tap water).
Implementation
Verify the doctor’s order.2
Confirm the patient’s identity using at least two patient identifiers according to facility policy.6
Explain the procedure to the patient and answer all questions to decrease anxiety and increase cooperation.
Take the patient’s vital signs, and auscultate his lung fields to establish a baseline.7
If possible, place the patient in a sitting or high Fowler’s position to encourage full lung expansion and promote aerosol dispersion.
For Large-Volume Nebulizer Therapy
Fill the water chamber to the indicated level with sterile distilled water. Avoid using saline solution to prevent corrosion. Add a heating device, if ordered, and place an in-line thermometer between the outlet port and the patient, as close to the patient as possible, to monitor the actual temperature of the inhaled gas and to avoid burning the patient.
If the unit will supply oxygen, set the built-in adjustable oxygen regulator or adjust the external oxygen blender to the ordered oxygen concentration and analyze the flow at the patient’s end of the tubing to ensure delivery of the prescribed oxygen percentage.
Attach the delivery device to the patient.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
