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Aerosolized Medication Treatment Via Small Volume Nebulizer (2.27)

Aerosolized Medication Treatment Via Small Volume Nebulizer (2.27) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Aerosol Therapy


2.27 Aerosolized Medication Treatment via Small Volume Nebulizer
Category: UWHC Patient Care Policy
Effective Date: December 1, 2016
Version: Revision
Manual: Respiratory Care Services
Section: Aerosol Therapy

I. PURPOSE: Medications are aerosolized to treat the airway and lung locally while minimizing
absorption and distribution throughout the body. For more agent specific indications refer to the related
link titled Administration of Aerosolized Medications – Pediatric/Adult – Inpatient/Ambulatory
Clinical Practice Guideline or refer to Micromedex on U-connect.

II. CONTRAINDICATION: Known hypersensitivity to the medication being delivered or a component of
the medication may cause an allergic reaction.

A. All patients will be assessed by the respiratory care practitioner (RCP).
B. Therapy will be provided in accordance with a physician’s order.
C. All patients will receive the appropriate Health Facts for You (HFFY)
D. Blow- by delivery is not acceptable.
E. Medication mixing instruction can be found in the related link.
F. Patients receiving more than one nebulized medication should receive their treatment in the
following order:
1. Bronchodilator
2. Hypertonic Saline (can be given with ACT)
3. Dnase (can be given with ACT)
4. Airway Clearance Technique
5. Aerosolized Antibiotic
6. Inhaled Steroid
G. All nebulized analgesic agents will be signed out by an RN. Any medication left over needs to
be discarded and witnessed by an RN.

A. Small Volume nebulizer (SVN)
1. Gas source
2. Oxygen tubing
3. Flowmeter
4. Mouthpiece, mask or nipple adapter
5. One link of corrugated tubing
6. Nose clips
B. Manual resuscitator for "bagging" with SVN
1. SVN
2. Flex tube with ETT adapter
3. Pressure manometer for pediatric patients
C. Delivery with Mechanical Ventilator
1. Elbow adaptor, 2 gum rubber adaptors, 1-15 mm adaptor
2. Hepa filters should be used when delivering all medications
3. Aerogen neb (see related link for necessary equipment).
D. Delivery with the following please refer to the Nebulizer Guidelines in the related links.
1. IPPB machine with circuit (see P&P #3:02 IPPB)
2. IPV machine with circuit (see P&P #3:14 IPV)
3. Continuous Nebulized Aerosol (see P&P #2:33).
4. Specialized Aerosol Treatment (see P&P #2:32).

A. Review and acknowledge the provider's order, which should include the type of medication, dose, and
B. Review the patient's chart.
C. Obtain the appropriate equipment.
D. Obtain and scan the medications.
E. For medication dilution instructions refer to the Inhaled Respiratory Medication related link
F. Introduce yourself to the patient and family. Explain the reason for the procedure.
G. Administration of a SVN to a non-ventilated patient.
1. When instructing the patient to use a SVN, the patient should be sitting upright and be taught
proper breathing techniques including passive breathing, maximal inhalation, and 3-5 seconds
breath hold.
2. Patients unable to use a mouthpiece may need:
a. An aerosol mask, trach mask or pediatric pacifier adapter.
b. Nose clips may be used to prevent the patient from breathing through their nose.
3. Proper steps will be taken after the delivery of steroid medications.
a. Rinse the mouth with liquid.
b. When using a mask, wipe the face with a wet wash cloth.
4. Prohibit eating or drinking for one hour after the delivery of inhaled lidocaine due to possible risk
of aspiration.
H. Administration of an SVN with Mechanical Ventilation:
1. Do not use an SVN in the pressure support mode. The additional flow may interfere with
patient triggering. Use a mode of ventilation with a set respiratory rate or a manual
resuscitator for proper medication delivery.
2. Place nebulizer into ventilator circuit on the dry side of the humidifier.
3. Remove HME (heated moisture exchanger) before delivering medication.
4. Place HEPA filter on the expiratory port of the ventilator. Failure to appropriately change
a filter may result in ineffective exhalation.
5. Decrease the delivered volume or delivered pressure on the ventilator to compensate for
the SVN's additional gas flow.
6. Peak pressure with the SVN running should be maintained at the pre-treatment pressure.
7. Keep expiratory filter in line for a few minutes after delivery, then remove.
8. After treatment, return ventilator to original settings.
I. Administration of SVN on a non-ventilated patient with an artificial airway.
1. A tracheostomy mask should be used with patients that have an artificial airway.
2. A manual resuscitator may be used with infants or patients who are unable to take a deep
J. The SVN and adapters should be allowed to air dry after each treatment. Refer to the Nebulizer
Guidelines related link for specific instructions for discarding all nebulizers.


A. AARC Clinical Practice Guidelines
1. Delivery of Aerosols to the Upper Airway
2. Selection of an Aerosol Delivery Device
3. Assessing Response to Bronchodilator Therapy at Point of Care
B. Respiratory Care (RC) P&P’s:
1. Specialized Aerosol Treatment #2.32
2. Continuous Medication Nebulization #2.33
3. Respiratory Care Assess and Treat Protocol #1.53
4. Cleaning and Monitoring of Patient Care Equipment #1:40
5. Inhaled Respiratory Medications Policy 2.25
C. Micromedics via computer.

1. Nebulizing Lidocaine Health Facts for You 5831
2. Nebulizer Respiratory Therapy Health Facts for You 6922)
3. Nebulizing Saline Health Facts for You 6355
4. Nebulizing Amphotericin B Health Facts for You 5370

Approved by Director and Medical Director of Respiratory Care: