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Continuous Nebulized Aerosols (2.33)

Continuous Nebulized Aerosols (2.33) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Aerosol Therapy

2.33




1

2.33 Continuous Nebulized Aerosols
Category: UWHC Patient Care Policy
Effective Date: October 1, 2015
Version: Revision
Manual: Respiratory Care Services
Section: Aerosol Therapy

I. PURPOSE

Continuous nebulization is used when a patient requires more than a standard dose of medication over a
prolonged period of time.

II. CONTRAINDICATION

Hypersensitivity to Albuterol or any of its components (refer to Micromedix).

III. POLICY

A. All patients will be assessed by the Respiratory Care Practitioner (RCP) to determine if the
appropriate indications for therapy are present.
B. Therapy will be provided in accordance with a provider’s order.
C. Patients must be in an intensive care unit, intermediate care unit, or emergency department.
D. Pharmacy will mix the Albuterol in a 60 ml bag. The concentration is 5 mg/ml. Medication will
take 30-60 minutes for delivery. Alert MD of delay and begin nebulization with unit dose vials
using the Bodyguard pump.
E. A Bodyguard pump will be used to deliver the Albuterol to the Aeroneb Solo nebulizer.
F. A continuous patient assessment will be done for the first 15 minutes.
G. Spot check the system every hour to confirm the presence of an aerosol.
H. Document every two hours a full system check.
I. Secure the nebulizer cup in an upright position to enhance nebulization.
J. The respiratory therapist will manage the administration of albuterol by inhalation and will
respond STAT when paged for Bodyguard pump alarms.
K. The Bodyguard pump will be locked during the administration of inhaled Albuterol to avoid
inadvertent dose changes. The pump key will remain with the respiratory therapist and handed
off at change of shift.
L. Patients receiving heliox as an oxygen delivery source see P&P 3.52 Heliox.

IV. EQUIPMENT

A. Bodyguard 575 Infusion Pump (Bodyguard pump)
B. Aeroneb Pro-X generator and aero neb solo nebulizer
C. Infusion tubing sets
D. Orange stickers labeled “Caution: Albuterol RT Inhalation Only.”
E. Tracking form
F. Non-ventilated patients
1. Appropriately sized aerosol mask
2. Link of ventilator tubing (4 ft.)
3. Blender on a pole
4. Reducer adaptor





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5. O2 tubing
6. 15 mm adaptor
7. O2 analyzer
8. If Bodyguard is not available: see related link.
a. Hope nebulizer
b. Aerosol mask.
G. Hi-ox mask with heliox blender set up. See RT P&P 3.52 Heliox.
H. High flow nasal cannula. See related link.
I. Ventilated patients see related link
1. Servo i with heliox. See P&P 3.52 Heliox
J. Dosing Guideline for Hope nebulizer see related link.

V. PROCEDURE

A. Review and acknowledge provider’s order.
B. Review patient's chart.
C. Obtain the appropriate equipment.
D Introduce yourself to the patient &/or family. Explain the reason for the procedure.
E. Obtain albuterol bag from pharmacy verifying volume of 60 ml and concentration 5mg/ml and
expiration date.
F. Bodyguard 575 pump set-up. See related link.
G. Adding additional medication: see related link.
H. With heliox: see related link and P&P 3.52 Heliox
I. Document the continuous albuterol administration on RT General Assessment doc flow sheet.
It is very important that start and stop times of medication administration are recorded in the
nebulization status row.

VI. REFERENCES

A. Respiratory Care Services (RCS) P&P;
1. #1:40 "Cleaning and Monitoring of Patient Care Equipment"
2. #3:52 "Helium"
B. Dosage Chart for Hope and Mini Heart




Approved by Director and Medical Director of Respiratory Care:

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