Nebulizers aerosolize specific topical medications that affect the lungs and airways. Inline nebuliser treatments deliver these medications to patients dependent on ventilators to breathe for them. In the past, extra air used to drive the nebuliser affected the amount of air delivered to the patient, but modern ventilators used in hospitals have built-in computers that compensate for this, thus not affecting the delivered volume of air.
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Indications for Inline Nebulizer Treatments
The most common drug administered via nebuliser is a bronchodilator, a medication that relaxes the muscles around the airways, reducing wheezing and easing breathing. You can also deliver mucolytics---drugs that liquefy mucus---certain antibiotics, epinephrine and even ethyl alcohol to break up the tiny bubbles associated with some severe cases of frothing pulmonary oedema (water build-up in the lungs) with a nebuliser. You cannot legally administer any medication without a prescription from the attending physician written in the patient's chart.
Assembling the Nebulizer
Remove the nebuliser from the sterile packaging and assemble as directed on the package insert. Use the T-tube adaptor only if the ventilator tubing does not contain a nebuliser port; all ventilator circuits used in American hospitals have such ports, but home-use circuits may not. If using the T-tube for home use, attach the included 500cc length of blue corrugated tubing to one end of the tube.
Use of the Nebulizer
Unstopper the nebuliser port and connect the top output port of the nebuliser cup to the input port on the circuit. For home circuits without such input ports, detach the ventilator tubing from the patient Y-connector after the temperature probe. Then, connect the 500cc length of blue corrugated tubing attached to the nebuliser to the Y-connector and attach the ventilator tubing to the T-tube atop the nebuliser, making sure that the nebuliser hangs down vertically. Add whatever medication your physician prescribes to the nebuliser cup (usually Albuterol). For respiratory therapists, you must be familiar with such medications, including possible adverse reactions and dosage, for if the doctor mistakenly orders a medication or a dose that is dangerous to the patient, you may share responsibility for the mistake. Respiratory therapists have the right to refuse to administer anything they believe will harm a patient, though they must justify such actions in their charting.
Compressed Gas Source for Nebulizer
All modern hospital ventilators have compressed gas outputs for nebulizers that deduct as much gas from each breath as is needed to channel through the nebuliser to vaporise medication, thus maintaining the same tidal and minute volumes (the amount of air delivered per breath and per minute) without changing the oxygen concentration. Connect the nebuliser pressure tubing to this port and turn the ventilator nebuliser on. Most will automatically shut down after a preset time period. For home ventilators, connect the nebuliser pressure tubing to a nebuliser air compressor or oxygen source, depending on your physician's orders. Nebuliser air compressors will deliver a flow of approximately six litres of room air per minute automatically. If using bottled oxygen to drive the nebuliser, set the flow meter to six litres per minute. Stop the treatment after five minutes or when the medication cup runs dry. Such home treatments will temporarily increase the patient's minute volume and oxygen concentration.
Removing Nebulizer from Circuit
Reverse the process used to add the nebuliser to the ventilator circuit. Be sure you turn off the flow of pressurised gas for the nebuliser, whether it comes from the ventilator, an air compressor or a flow meter. If you used bottled oxygen for a home nebuliser treatment, also close the top of the oxygen cylinder or it may leak slightly. Place the used nebuliser in a clean equipment bag and hang the bag from the flow meter or from the ventilator's compressed gas output port. You can reuse nebulizers safely for up to 48 hours as long as you use proper clean techniques while handling them.
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