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NT skills update - THE USE OF NEBULISERS

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Abstract

WHAT ARE NEBULISERS?

VOL: 99, ISSUE: 07, PAGE NO: 29

WHAT ARE NEBULISERS?
- The word nebuliser comes from the Latin word nebula, meaning mist.

 

- A nebuliser is a small plastic device that contains a drug in solution. By means of a compressor/compressed gas source, the device converts the drug into an aerosol form.

 

- The drug is then inhaled during tidal breathing over a period of between five and 15 minutes at a flow rate most appropriate to the drug being administered (usually 6-8l/min).

 

- It is the responsibility of the NHS to provide an adequate nebuliser service if the prescribing physician decides that it is a necessary part of a patient’s NHS treatment.

 

ADVANTAGES
- Nebulisers deliver large doses of drug simply and effectively.

 

- Using a nebuliser, drugs for inhalation can be administered rapidly to people who are too ill to use hand-held devices such as metered-dose inhalers.

 

SUITABLE MEDICATIONS
- Bronchodilators (beta 2 agonists such as salbutamol).

 

- Anticholinergics (such as ipratropium bromide).

 

- Corticosteroids (such as beclometasone).

 

- Antibiotics and anti-fungals (such as tobramycin, amphotericin).

 

- Mucolytics (such as dornase alfa).

 

- Saline.

 

- Other solutions can be delivered to assess airway responsiveness (for example, histamine to measure bronchoconstriction and citric acid to examine the cough response).

 

DELIVERY METHODS
- Jet nebulisers are the type most commonly used. A flow of gas passing through a very small hole creates a negative pressure that sucks the solution from its reservoir, forming a mist for the patient to inhale.

 

- These nebulisers are used in conjunction with either compressed gas (wall-mounted or cylinder) or a compressor and filter for home use. Nebulisers are also available for use when travelling abroad. These models use dual voltage batteries and can run from a 12V car battery.

 

MASK OR MOUTHPIECE?
- A mouthpiece is recommended when nebulising steroids, anticholinergics or antibiotics. When nebulising antibiotics a filter system should be used to ensure they are not released into the atmosphere.

 

- Face masks are better for infants, young children, and emergencies.

 

- Masks must fit closely to the face.

 

- Children’s faces should be washed after nebulising steroids.

 

- A mouthpiece is preferable for patients with glaucoma as pupillary dilation can occur if bronchodilators come into contact with the eyes.

 

INFECTION CONTROL AND MAINTENANCE
- In hospital nebulisers should be for single-patient use. After use the compressor should be washed in warm soapy water.

 

- To avoid cross infection, separate compressors should be allocated to patients who are methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas cepacia positive.

 

- Durable nebulisers are available for home use. After each use, the nebuliser, tubing and compressor should be washed in warm soapy water.

 

- The compressors have a small air inlet filter that should be changed every nine to 12 months.

 

- Many trusts have policies regarding servicing of nebuliser equipment. Maintenance should adhere to manufacturer’s guidelines.

 

 


 

 

FURTHER READING
British Thoracic Society et al (1997)British guidelines on asthma management. Thorax; 52 (Suppl 1).
British Thoracic Society (1997)BTS guidelines for the management of chronic obstructive pulmonary disease. Thorax; 52 (Suppl 5).
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