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Inhaled Pentamidine (2.32)

Inhaled Pentamidine (2.32) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Aerosol Therapy

2.32


2.32 Inhaled Pentamidine
Category: UWHC Patient Care Policy
Effective Date: December 1, 2016 Version: Revision
Manual: Respiratory Care Services
Section: Aerosol Therapy

I. DESCRIPTION

Inhaled Pentamidine is administered to immunocompromised patients for the treatment or prevention of
Pneumocystis (carinii) Jiroveci Pneumonia. This medication must be delivered appropriately to avoid secondary
exposure to others.

II. CONTRAINDICATIONS

A. Patients with active bronchospasm should not receive inhaled pentamidine.
B. Pentamidine has been linked to birth defects. Pregnant patients should not receive this drug without first
consulting a physician.

III. COMPLICATIONS/PRECAUTIONS

A. Conjunctivitis.
B. Severe cough.
C. Burning sensation in back of throat may occur.

IV. POLICY

A. All Patients will be assessed by a Respiratory Care Practitioner (RCP) to determine if the appropriate
indications for the therapy are present.
B. Therapy will be provided in accordance with a provider’s order.
C. All patients will receive the appropriate Health Facts for You (HFFY).
D. Unnecessary exposure to the aerosolized drug must be minimized. Please refer to the related link from
Hospital Policy 8.89 (Attachment 1-Employee Handout on Hazardous Drugs).
E. Employees concerned about exposure are encouraged to communicate with their supervisor and their
personal physician about how exposure could affect them. Further concerns should be directed to
Employee Health.
F. The following steps should be followed per OSHA recommendations:
1. A closed system delivery device with one way valve is always used to deliver the medication.
2. If pentamidine is not administered in a negative airflow room, wall suction must be used for
scavenging the medication. The only exception to this is mechanically ventilated patients.
3. During administration of pentamidine, a disposable gown, nitrile gloves, safety glasses, a
particulate filter mask or Powered Air Purifying Respirator (PAPR) must be worn by the RCP.
4. Limit the number of visitors/caregivers in the room during pentamidine administration. Those
individuals that must stay in the room at the time of administration must wear personal protective
equipment as mentioned in number 3 above.
5. Pre-medication with bronchodilators is performed to prevent bronchospasm.
6. Inpatient pentamidine administration will be provided in the patient’s room, with the door
closed for 30 minutes after therapy is completed. A sign is placed on the door that notifies
visitors that a particulate mask must be worn until 30 minutes after therapy was completed.
7. Patients that are mechanically ventilated and receiving pentamidine will have a double HEPA
filter added to the expiratory side of the circuit to filter the medication. They do not have to be
placed in a negative air flow room.
G. Outpatient treatments for adult treatments are prescheduled through the RCPs in Pulmonary Clinic, on
cell phone number 669-7024. This number does have voice mail. They also carry pager 7600. These
therapies will be performed in negative airflow rooms B6/284 and B6/285.

H. Outpatient treatments for pediatric patients are prescheduled through Pediatric Day Treatment/Sedation
and Peds Specialty Clinics at 262-4402 extension 1. These therapies will be performed in bay 3, room
1232, in the American Family Children’s Hospital.
I. All “no show” appointments will be reported to ordering physician.

V. EQUIPMENT

A. Albuterol MDI or nebulized solution whichever is preferred.
B. Small Volume Nebulizer (SVN) which incorporates a filter for use in negative airflow rooms, or
scavenger system for use in rooms that do not have negative airflow.
C. Isolation sign.
D. Suction gauge.
E. Suction connective tubing.
F. Additional outpatient supplies
1. 1 18 gauge needle
2. Alcohol swabs
3. 1 10 mL syringe
4. 1 10 mL vial of sterile water
5. 1 vial of 300 mcg pentamidine lyophilized
G. Two HEPA filters and a standard SVN for mechanically ventilated patients
H. Personal Protective Equipment (PPE)
1. Nitrile gloves
2. A disposable gown
3. Safety goggles
4. A particulate filter mask or PAPR.
a. RCPs are responsible for obtaining the appropriately sized particulate filter mask from
central supply stock on the nursing units. If the appropriate size is not available, the
therapist must obtain the correct size from central supply before performing the therapy.
b. The PAPR device may be obtained from Central Services in D6/140.

VI. PROCEDURE

A. Review and acknowledge the provider’s order, which should include the type of medication,
pre-medication (if indicated), dose and frequency.
B. Review patient's chart or medical history.
C. Obtain the appropriate equipment.
D. Place isolation sign outside door. Door should be closed during treatment and one half hour after
treatment is completed.
E. Introduce yourself to the patient and/or family. Explain the reason for the procedure.
F. Give the patient a “Health Facts for You,” and explain the procedure.
G. Use the appropriate scanning procedure to sign out the medication.
H. Albuterol is administered prior to the nebulized pentamidine to prevent bronchospasm. See the related
link titled “Aerosolized Medications.”
I. Position the patient supine. The head of their bed may be raised, but no more than 20 degrees to improve
deposition to the upper lobes.
J. If the patient is ventilated, place two HEPS filters on the expiratory side of the ventilator to scavenge the
drug. This is the only scavenging system that is needed.
K. Attach wall suction to set-up, if administering the medication in a room that does not have negative air
flow. Use a setting of -10 -20 cm H2O of suction.
L. Don personal protective equipment.
M. Assemble specialized nebulizer set-up.
N. Additional steps if performed in the adult outpatient clinic,
1. Draw up 6 mL of sterile water and inject into vial of pentamidine. Mix thoroughly
2. Draw up solution once it is completely dissolved and place in nebulizer cup.


O. Run flowmeter to nebulizer at 6-10 LPM.

P. Instruct patient on proper breathing techniques, passive breathing, maximum inhalation and breath-
holding.
Q. Monitor vital signs and breath sounds before, during, and after the treatment.
R. If an adverse reaction occurs, stop the treatment, assess patient, and notify the MD.
S. Cleaning or disposing of equipment.
1. Discard the nebulizer, medication vials, and PPE in a black pharmaceutical waste container.
2. In the adult outpatient clinic, all vertical surfaces of the room must be sprayed and wiped with
hospital germicide. The room must air out for 30 minutes after therapy is complete.
3. In the pediatric outpatient clinic, 30 minutes after therapy has been completed, environmental
services will clean the room.

VII. REFERENCES

A. Micromedics via Computer.
B. Health Facts for You - Aerosolized Pentamidine, #5527.
C. Inhaled Respiratory Medications (policy related link)
D. Respiratory Care Policy & Procedure 2.27 Aerosolized Medication Treatment via Small Volume
Nebulizer.
E. UWHC Administrative Policy 8.89 Preventing Occupational Exposure to Hazardous Drugs.


Approved by Director and Medical Director of Respiratory Care:

A copy of this Policy & Procedure is available in the Respiratory Care Office [E5/489].