Nebulizer Therapy

• Nebulizer therapy aids bronchial hygiene by restoring and maintaining mucus blanket continuity, hydrating dried secretions, promoting secretion expectoration, humidifying inspired oxygen, and delivering drugs.
• It may be given through nebulizers that have a large or small volume, are ultrasonic, or are placed inside ventilator tubing.
• Large volume nebulizers such as Venturi Jet provide humidity for an artificial airway.
• Small volume nebulizer such as Mini Nebulizer is used to deliver drugs such as bronchodilators.
• Ultrasonic nebulizers are electrically driven and use high-frequency vibrations to break up surface water into particles; resultant dense mist can penetrate smaller airways, hydrate secretions, and induce coughing.
• In line nebulizers are used to deliver drugs to patients being mechanically ventilated.

Equipment

For ultrasonic nebulizer

• Untrasonic gas delivery device
• Large bore oxygen tubing
• Nebulizer couplet compartment

For a large-volume nebulizer

• Pressurized gas source
• Flowmeter
• Large-bore oxygen
• Nebulizer bottle
• Sterile distilled water
• Heater
• Inline thermometer

For a small-volume nebulizer

• Pressurized gas source
• Flowmeter
• Oxygen tubing
• Nebulizer cup
• Mouthpiece or mask
• Normal saline solution
• Prescribed drug

For an in-line nebulizer

• Pressurized gas source
• Flowmeter
• Nebulizer cup
• Normal saline solution
• Prescribed drug

Preparation of Equipment

For an ultrasonic nebulizer

• Fill the couplet compartment to the indicated level.

For a large-volume nebulizer

• Fill with distilled water to the indicated level
• Avoid using normal saline solution, to prevent corrosion
• Add a heating device if ordered
• Ensure delivery of the prescribed oxygen percentage

For a small-volume nebulizer

• Draw up the drug, inject it into the nebulizer cup, and add the prescribed amount of normal saline solution, or water.
• Attach the mouth piece, mask, or other gas delivery device.

For an in-line nebulizer

• Draw up the drug and diluents, remove the nebulizer cup, quickly inject the drug, then replace the cup.
• If using an intermittent positive-pressure breathing machine, attach the mouthpiece and mask to the machine.

Procedure

• Reinforce the explanation of the procedure to the patient
• Wash hands
• Take the patient’s vital signs and monitor his respiratory status.
• Place the patient in a sitting or high fowler’s position

For an ultrasonic nebulizer

• Give an inhaled bronchodilator to prevent bronchospasm
• Turn the machine on and check the outflow port for proper misting
• Monitor the patient for adverse reactions
• Watch for labored respirations
• Take the patients vital signs and monitor his respiratory status.
• Encourage the patient to cough and expectorate, or suction him as needed.

For a large volume nebulizer

• Attach the delivery device to the patient
• Encourage the patient to cough and expectorate, or suction him as needed
• Check the water level in the nebulizer and refill it, as indicated
• When refilling a reusable container, discard the old water
• Change the nebulizer unit and tubing according to hospital policy.
• If the nebulizer is heated, tell the patient to report discomfort.

For a small volume nebulizer

• Attach the flow meter to the gas source
• Attach the nebulizer to the flowmeter and adjust the flow to at least 10L
• Check the outflow port to ensure adequate misting
• Remain with the patient during treatment
• Encourage the patient to cough and expectorate
• Change the nebulizer cup and tubing according to your facility’s policy.

For an in-line nebulizer

• Turn on the machine and check for proper misting
• Remain with the patient during treatment
• Take the patient’s vital signs and monitor him for adverse reactions
• Encourage the patient to cough, and suction excess secretions as necessary.
• Monitor the patient’s respiratory status to evaluate the effectiveness of therapy.

Nursing Interventions

1. The efficacy of aerosol therapy, what type of fluids to use, the types of drugs that can be delivered, and the effectiveness of therapy, haven’t been established.
2. Monitor for overhydration, especially in the patient with a delicate fluid balance.
3. Carefully monitor for adequate flow if oxygen is being delivered at the same time.
4. Encourage the patient to take slow, even breaths to derive maximum benefit.

Complications

• Mucosa irritation, bronshospasm, dyspnea, airway burns, infection and adverse drug reactions.

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