How to Use a Metered Dose Inhaler

It’s Abbie’s first week of being exposed in the clinical area and being eager to learn, she makes it a point to always observe and learn from the procedures the staff nurses perform. “Uhm, excuse me, ma’am, may I know what procedures you will be doing today?” she finds herself asking a female staff nurse. “I will be instructing a patient how to use a metered dose inhaler,” the staff nurse calmly answers and her interest is piqued.

Both curious and interested to learn, she asks the staff nurse if she could watch as she gives instruction to the patient and the staff nurse nods in agreement. Walking towards the patient’s room, she tries to control her excitement as she accompanies the staff nurse, happy that at the end of the day, another procedure will be added to her learnings.

Administering an MDI

An MDI is an aerosol canister filled with medicine. Basically, it is in a plastic holder with a mouthpiece. There are two methods for using an MDI. Usually, the preferred method is with a device called a valved holding chamber, which attaches to the MDI and hold the “spray” of medication. They make it easier to use the MDI and help get the medication into the lungs better. An MDI can also be used without a chamber.

Below are the steps when administering an MDI with a valved holding chamber, and without chamber as well as how to clean it.

Using an MDI with a valved holding chamber

  1. Remove the cap from the MDI and chamber.
  2. Shake well for 5 seconds.
  3. Insert the MDI into the open end of the chamber (opposite the mouthpiece).
  4. Breathe out all the way.
  5. Keep your chin up.
  6. Place the mouthpiece of the chamber between your teeth and seal your lips tightly around it.
  7. Press the canister once.
  8. Breathe in slowly through your mouth to completely fill your lungs. If you hear a “horn-like” sound, you are breathing too quickly and need to slow down.
  9. Hold your breath for 10 seconds (count to 10 slowly) to allow the medication to reach the airways of the lung.
  10. Repeat steps 2-8 for each puff ordered by your doctor. Wait about 1 minute in between puffs.
  11. Replace the cap on your MDI when finished.
  12. If you are using a corticosteroid MDI, rinse your mouth and gargle using water or mouthwash after each use. You should always use a chamber with a steroid MDI.
  13. If you are using a corticosteroid MDI, rinse your mouth and gargle using water or mouthwash after each use. You should always use a chamber with a steroid MDI.

Using an MDI without a chamber

  1. Remove the cap from the MDI and shake well for 5 seconds.
  2. Breathe out all the way.
  3. Keep your chin up.
  4. Place the mouthpiece of the inhaler between your teeth and seal your lips tightly around it.
  5. As you start to breathe in slowly, press down on the canister one time.
  6. Keep breathing in slowly to completely fill your lungs. (It should take about 5 to 7 seconds for you to completely breathe in.)
  7. Hold your breath for 10 seconds (count to 10 slowly) to allow the medication to reach the airways of the lung.
  8. Repeat the above steps for each puff ordered by your doctor. Wait about 1 minute between puffs.
  9. Replace the cap on the MDI when finished.
  10. If you are using a corticosteroid MDI, you should use a valved holding chamber as described above.

Cleaning Your MDI

To clean your MDI, follow the instructions that came with it. In most cases, they will advise you to:

  1. Remove the metal canister by pulling it out.
  2. Clean the plastic parts of the device using mild soap and water. (Never wash the metal canister or put it in water.)
  3. Let the plastic parts dry in the air (for example, leave them out overnight).
  4. Put the MDI back together.
  5. Test the MDI by releasing a puff into the air.

 

Sources:

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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