NURS 00 - NEBULIZER

1. Introduction
A nebulizer changes liquid medicine into fine droplets (in aerosol or
mist form) that are inhaled through a mouthpiece or mask. Nebulizers
can be used to deliver bronchodilator (airway opening) medicines such
as albuterol (ventolin, Proventil or Airet) or ipratropium bromide
(Atrovent).
Nebulizer are known to harbor hydrophilic bacteria e. g Pseudomonas
aeruginosa and other gram-negative organism that can be nebulized
during use increasing a patients risk of acquiring Pneumonia.
2. Policy
2.1 The Staff Nurse shall be knowdgeable on types of Nebulizer
treatments.
2.2
2.3

All aerosolized treatments shall be prescribed by a Doctor.

The Staff Nurse must ensure that all multi dose vials must have
date and time indicated on vials to check for expiry.
2.4Multi-dose medication bottles must be labeled with patients name to
indicate for a particulars patient use only. Use single use ampoules if
not available.

2.5

All patients receiving nebulizers treatment shall have their own

devices
2.6All in line and handheld nebulizers must be cleaned, disinfected
and rinsed with sterile water and dried between treatment of the same
patient.
NURS 00 Nebulizer

2.7For all multi-dose nebulizers treatment use new ampoule of sterile

fluid and new sterile syringes each time.
2.8The nurse shall ensure that patient and family should have information
prior to treatment.
2.9According to our UHS Policy of infection control you should clean and
disinfect the Nebulizer set.
3.0 Equipment
3.1 Stethoscope
3.2 Small Volume Nebulizer
3.3 Medication
3.4 Small bore connective tubing
3.5 Aerosol Face Mask (Optional) / Trach mask (Optional)
3.6 Air or Oxygen flow meter with appropriate nipple adapter
3.7 Plastic Treatment/Equipment Setup bag
4.0 Procedure
4.1 Obtain the necessary equipment in the respiratory therapy equipment
Room or designated respiratory supply cabinet for the unit. Proceed to
the patients nursing unit.
4.2 Read the patients order sheet for the doctors specific instructions.
Verify medication dosage, frequency, and duration of therapy, if
specified. Review the patients chart for admission diagnosis, medical
history, therapeutic indications and possible contraindications. Verify
the patients name, DOB, and bed location.
4.3 Proceed to patients bed, introduce yourself, and explain what you are
about to do and that it has been ordered by the patients doctor. Check
the patients name and DOB verbally and by the patients wrist band. Be
reassuring.
NURS 00 Nebulizer

4.4 Explain the desired outcome goal for the treatment. Explain what the
patient must do to receive the treatment and that specific instructions will
be provided to promote the desired effect and administration of the
nebulizer treatment.
4.5 Wash your hands. Observe universal precautions.
4.6 If the patients requires suctioning, suction in accordance with
department policy and procedures.
4.7 If a patient is asthmatic, measure and record Peak Flow pre and post
treatment.
4.8 Connect flow meter with nipple adapter to gas source outlet. Attach one
end of the small bore connective tubing to the nipple adapter and the
other end to the inlet port of the Nebulizer.
4.9 Position patient so that the nebulizer will be in a vertical position when
either the mouthpiece or aerosol face mask is being used by the patient.
Patient should be sitting as straight as possible, semi-fowler position
preferably.
4.10 Instruct patient in proper techniques for effective Rx (breathing pattern,
inspiratory depth, and breath holds.
4.10.1 For aerosol treatment with mouthpiece, instruct patient to
inspire/exhale aerosolized medication (mist) through the
mouthpiece with closed lips around mouthpiece to maintain seal
4.10.2 For aerosol treatments with aerosol face masks, instruct patient
to inspire/ exhale aerosolized medication (mist) through a
slightly open mouth.

NURS 00 Nebulizer

4.10.3 The pattern of their breaths (inhalation/exhalation phase) during

the treatment period will be slow, normal depth (normal tidal
breath volume Vt <.5L/sec)
4.10.4 Periodically the patient will provide slow, deeper breaths
(approaching TLC) with a breath hold performed for 4-10 second
as patient tolerates.
4.11 Record respiratory clinical assessment of patient before Rx on the patients
Respiratory Care Treatment sheet located on the patient bedside clipboard (be
sure to include breath sounds, heart rate, respiratory rate, cough and
secretions assessment, SaO2, supplemental O2 / delivery device, and peak
flow if applicant).
4.12 Observe the patient for any signs of hyperventilation or adverse reactions to
medications. Treatment time generally is less than 10 minutes. Instruct
patient and encourage patient to cough so as to raise secretions. Suction, if
necessary, in accordance with departmental policy and procedures.
4.1.1 Cleaning/Disinfection of Nebulizers Use Any of the Following
Disinfectants:

Hydrogen Peroxide
Clean with soap and water, and rinse
Place in 3% hydrogen peroxide for a minimum 20 minutes soak.
Next, thoroughly rinse with sterile water.
Air dry and store in a plastic bag.
Peroxide solution should be changed every shift and labeled
with date and time.

4.1.2 Methylated Spirit (Isopropyl Alcohol)

Wash nebulizer with soap and water, rinse.
Place in 70% isopropyl alcohol for a minimum 20 minutes soak
NURS 00 Nebulizer

thoroughly, rinse with sterile water.

Dry with forced air or air dry.
4.1.3 Cidex Orthophalaldehyde (Cidex OPA) Only ICU &
Endoscopy
Wash nebulizer with soap and water, rinse
Place in Cidex OPA following manufacturers instructions.
5.0 Cross Referencing / Associated Policy (s)
5.1 University Hospital Sharjah / Infection Control : Hand washing nonSurgical.
5.2 University Hospital Sharjah / Respiratory Department Policy ;
Nebulizer
6.0 References
6.1 Walker J. Fell B (2005) Respiratory Care. Association for Professional in
Infection Control and Epidemiology, Inc.
6.2 Tablan OC. Anderson LJ.Besser R. Bridges C. Hajjeh R (2003).
6.3 Guidelines for Preventig Health-Care-Associated Pneumonia. Center for
Disease Control, 53 (RR03)
6.4 AARC Clinical Practice Guidelines, 1993
6.5 Respiratory Care: A Guide to Clinical Practice, Fourth Edition 1998

NURS 00 Nebulizer

Policy & Procedure Approval and Authorization Signatures

Prepared
_______________________
Print Name

_________________
Signature

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Date

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Signature

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Date

Approved by
Name of the Relevant Head
Department Head of Department
________________________
Print Name
Authorized by
Executive
Director
Validated by
P&P
Representative

______________________
Print Name

__________________
Signature

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Date

__________________________
Print Name

___________________
Signature

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Date

Authorized by
Chief Executive
Mr. Nigel Weale
Officer
__________________________
Print Name

Original Date:
17/08/2011
Review / Amended Date: xx/xxxx/xxxx

NURS 00 Nebulizer

____________________
Signature

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Date