Aerosol Therapy
1. Route: Aerosol Therapy refers to the aersolization of solution for
inhalation via:
1.1 Nebulizer
1.1.1
face mask (section 5)
1.1.2
in line in ventilator (section 6)
1.1.3
bagged in with manual ventilator (section 7)
1.2 Metered dose inhaler (MDI) with a spacer
device..
1.2.1
face mask (section 8)
1.2.2
in line in ventilator (section 9)
1.2.3
bagged in with manual ventilator (section 10)
2. Indications & Dosage
2.1 Medications given by microneb, their indications,
doses, methods of action, cautions and
contraindications
can be obtained in the NEOFAX manual,
2.1.1 the most
current version of which is permanantly kept in the Respiratory Lab in
Equipment Manual Book #1.
3. Documentation
3.1 All microneb & MDI treatments require a
written physicians order.
3.1.1 MDI orders shall specifty
3.1.1.1 specific medication
3.1.1.2 frequency of treatment
3.1.1.3 number of puffs
3.1.1.4 number of breaths per puff
3.1.2 Micronebulizer orders shall specify:
3.1.2.1 specific medication
3.1.2.2 frequaency of treatment
3.1.2.3 volume of medication (calculated in miligrams)
3.1.2.4 volume of dilutant (saline, H2O, etc.)
3.2 Adverse reactions to therapy will be reported
to the physician & be documented in the permanant
record
3.3 Respiratory Care Practitioners (RCPs) shall sign the medsheet for medications that they draw and deliver. RCPs shall initial the medsheet for each dose delivered.
4. Responsibility for Delivery
4.1 RCPs shall deliver all aerosolized medications
to patients who are receiving positive pressure &/or
have an artificial airway.
5. Mask Nebulizer Treaments
5.1 Equipment needed:
5.1.1
Microneb unit
5.1.2
O2 tubing
5.1.3
O2 face mask
5.1.4
O2 blender flowmeter or air flowmeter.
Brigham & Women’s Neonatal Respiratory Care
Policy & Procedure Manual
Reviewed page 2 of 4
Aerosol Therapy
5. Mask Nebulizer Treaments (ctd)
5.2 Procedure:
5.2.1. Place
mask on top of nebulizer
5.2.2. Attach
O2 tubing to bottom of nebulizer and the other_end of tubing to the flowmeter
of:
a selected FiO2 on_a blender or air flowmeter
5.2.3. Add prescribed
amount of medications to nebulizer.
5.2.4. Turn
flowmeter to 4-6 l/m. Assure adequate mist_output.
5.2.5. Place
face mask on patient. Monitor patient's heart_rate, etc. during treatment.
5.2.6
After medication is nebulized, remove mask and turn_off flowmeter.
5.2.7
Rinse nebulizer with sterile water. Dry with sterile_gauze and return
mask nebulizer to
patients equipment_bag.
6. Inline with Vent Nebulizer Treatments
6.1 Equipment needed:
6.1.1 Micronebulizer
with O2 tubing, "T" (Intec) adapter, O2 blender or air flowmeter.
6.2 Procedure:
6.2.1. Place
(Intec) T adapter on top of nebulizer.
6.2.2. Attach
on end of O2 tubing to the bottom of the_nebulizer and the other end to
the
flowmeter of a_blender with the prescribed FiO2 the patient is_ordered
for.
6.2.3. Fill
nebulizer cup with prescribed medication.
6.2.4. Insert
nebulizer on the inspiratory side of the_ventilator circuit at the patient
"Y".
6.2.5. Turn
the nebulizer's flowmeter to 4-6 l/m and assure_adequate mist output.
6.2.6.
Immediately reduce the ventilator flow rate by the_same liter flow set
on the nebulizer
flowmeter. The_peep and pip should remain constant before, during
and_after the
treatment. Monitor patient's heart rate, O2 saturation,etc. during
treatment.
6.2.7.
When the medication has been nebulized, turn off the_nebulizer flowmeter
and readjust
ventilator flowmeter_to the pre-treatment liter flow.
6.2.8.
Remove nebulizer from patient's ventilator circuit and_rinse nebulizer
with sterile water
and dry with_sterile gauze pad (2" x 2"). Return to patient's_equipment
bag.
6.2.9.
Recheck ventilator pip and peep to assure prescribed_ventilator setting.
7. Med Neb Treatment via Manual Ventilator
7.1 Equipment needed:
7.1.1
rubber adapter
7.1.2
metal Mapleson "T"
7.1.3
trach swivel adapter
7.1.4 manual
ventilator (checked).
Brigham & Women’s Neonatal Respiratory Care
Policy & Procedure Manual
Reviewed page 3 of 4
Aerosol Therapy
7. Med Neb Treatment via Manual Ventilator (ctd.)
7.2 Procedure:
7.2.1. Obtain
physician's order.
7.2.2. Place
Briggs adapter on top of neb and place rubber adapter at both ends, place
metal "T" and
trach swivel at end of one rubber adapter.
7.2.3. Place
prescribed medication in med neb.
7.2.4. Place
O2 tubing on bottom of neb and attach to O2 source with equal Fio2 to manual
ventilator.
7.2.5. Attach
med neb set up to elbow/pop-off of Mapleson (omit "T" for manometer here
and use
"T" in med neb set up to monitor patient pressure). Attach trach
swivel to ett if patient is
intubated. Attach mask if patient is not intubated.
7.2.6. Turn on med
neb flow source to 4-6 lpm Turn down flow dependant manual ventilator flow
source so that total flow does not exceed 8 lpm.. Check for adequate
mist.
7.2.7 Bag in
med neb treatment as you would manually ventilate at patient. Long inspiratory
time
breaths are ideal.
7.2.8. Monitor patient
during treatment. Observe closely for adverse reactions to therapy
7.2.9. When treatment
is completed, return patient to previous therapy (or room air).
7.2.10.Rinse med neb
with sterile water and store in patient set up bag.
8. Mask MDI/Spacer Treaments
8.1 Equipment needed:
8.1.1
metered dose cartridge per MD order
8.1.2
spacer with proper mask fit per NEWBORN RESUSCITATION standards.
8.1.3
manual ventilator on standby
8.1.4
O2 suppliment to sustain O2 saturation
8.2 Procedure:
8.2.1
Obtain a physicians order for:
8.2.1.1 Specific medication
8.2.1.2 Number off actuations (puffs)
8.2.1.3 Number of patient breaths or manual ventilations per actuation
8.2.2
Shake the MDI cartridge
8.2.3
Place the cartridge in the spacer’s holding chamber
8.2.4
Actuate the cardridge
8.2.5
Apply the mask to the face
8.2.6
Assure proper number of breaths (common range 5-10)
8.2.7
Monitor patient's heart rate, etc. during treatment.
8.2.8
Repeat as ordered, as tolerated
8.2.9
return mask nebulizer to patients equipment bag.
Brigham & Women’s Neonatal Respiratory Care
Policy & Procedure Manual
Reviewed page 1 of 4
Aerosol Therapy
9. Inline with Mechanical Ventilator MDI Treatment
9.1 Equipment needed:
9.1.1 MDI, spacer & connections for ventilator
(15mmI.D.) & airway (15mm O.D.)
9.1.1.1 Assure that spacer is labeled with date placed in service
& date < wk. old.
9.2 Procedure:
9.2.1 Place spacer betweem the ventilator circuit
and the endotracheal tube
9.2.2 Select and MDI cartridge and shake vigorously
9.2.3 Attach MDI cartridge to spacer and actuate.
9.2.3.1 Wait 30 seconds before repeating actuation of that
cartridge
9.2.4 Assure that the prescribed number of breaths
are delivered throught the spacer.
9.2.5 The PEEP and PIP should remain constant before,
during and after the tx.
9.2.6 Monitor the patient’s heart rate O2 sat.
etc. before, during & after tx.
9.2.7 Remove spacer from in-line without creating
back & forth movement of the ETT.
9.2.8 Place spacer in clean equipment bag
]
10. Med Neb Treatment via Manual Ventilator
10.1 Equipment needed:
10.1.1 metered dose cartridge per MD order
10.1.2 spacer with proper mask fit per NEWBORN RESUSCITATION standards.
10.1.2.1 Use spacer with no one-way-valves when manual ventilation
is necessary.
10.1.3 flow inflating manual ventilator for spacer with no valves
if O2 suppliment or positive
pressure required
10.1.4 O2 suppliment to sustain O2 saturation
10.2 Procedure:
10.2.1 Obtain a physicians order for:
10.2.1.1 Specific medication
10.2.1.2 Number off actuations (puffs)
10.2.1.3 Number of patient breaths or manual ventilations per actuation
10.2.2 Setup
10.2.2.1 Place spacer between airway and manual ventilator
10.2.2.2. Shake the MDI cartridge
.
10.2.3 Place the cartridge in the spacer’s holding chamber
10.2.4 Actuate the cardridge
10.2.5 Attach ett if patient is intubated. Attach mask if patient
is not intubated.
10.2.6 Assure proper number of breaths (common range 5-10) flow dependant
manual ventilator
flow source so that total flow does not exceed 8 lpm..
10.2.7 Bag in med neb treatment as you would manually ventilate
at patient. Long inspiratory time breaths are ideal. Limit number
of breaths per order
10.2.8 Monitor patient during treatment. Observe closely
for adverse reactions to therapy
10.2.9 Repeat as ordered, as tolerated
10.2.10 When treatment is completed, return patient to previous therapy
(or room air).