205.5 Continuous Nebulizer Treatment / Page 1 of 5

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1 205.5 Continuous Nebulizer Treatment / Page 1 of 5 Description The Mini HEART and HEART nebulizers are used to deliver continuous aerosolized bronchodilator (Albuterol) to ventilated and non-ventilated patients. The nebulizers produce a high-density aerosol with a particle size of 2-3 microns. The larger reservoir makes it possible to nebulize medication continuously for several hours. The nebulizers are powered by compressed air unless otherwise specified in the physician's orders. The Mini Heart nebulizer is used for inline treatments on mechanically ventilated patients or patients on BiPAP. It has an aerosol output of 8 ml per hour at a flow rate of 2 liters per minute and a reservoir capacity of 30 ml. The lower flow rate used with this nebulizer reduces the interference with the ventilator triggering mechanism. The HEART nebulizer is used for treatments on spontaneously breathing patients with an aerosol mask. It has an aerosol output of 50 ml per hour at a flow rate of 15 liters per minute and a reservoir capacity of 240 ml. Physician's Orders (Type of medication) and (dose per hour) nebulized continuously. The medication is diluted with normal saline unless otherwise specified. The diluent volume is determined by the dose per hour and the type of nebulizer used. Mini HEART Nebulizer Procedure for Ventilated patients and patient s on BiPAP Equipment Needed Appropriate flowmeter with nipple adapter Oxygen tubing MiniHEART nebulizer 2 Cuff adapters T adapter 12 inch length aerosol tubing Procedure 1. Assemble equipment in the patient's room.

2 205.5 Continuous Nebulizer Treatment / Page 2 of 5 2. Mix medication and fill the nebulizer. A total volume of 24 ml should be mixed. The MiniHEART nebulizer output is 8 ml per hour when flow rate is set to 2 L/min. 3. To set up a mixture that will last 3 hours, see following chart. These ratios are based on an Albuterol Solution of 5 mg / ml (The solution in the large glass vial, available from pharmacy) Dose Desired (mg / hr) Albuterol (5mg/ml) NS Total Volume 5 mg 3 ml (15 mg) 21 ml 24 ml 10 mg 6 ml (30 mg) 18 ml 24 ml 15 mg 9 ml (45 mg) 15 ml 24 ml 4. Place the Mini HEART nebulizer on the inspiratory side of the patient Y with the 12 inch length of aerosol tubing placed between the Y and the nebulizer to function as a reservoir. 5. Set the flowmeter to 2 L/min. 6. Discard the filters after the daily nebulizer change, or whenever increased expiratory resistance is noted. 7. Monitor the patient during the treatment. Assess the patient s pulse, respiratory rate, and other parameters once every hour. If any adverse side effects occur (see below), discontinue treatment immediately and notify the physician and document the event. 8. Use all of the medication. At the end of the treatment, disassemble and empty the residual solution out of the nebulizer and place in a clean area. Large HEART Nebulizer Procedure for Aerosol Mask Treatments Equipment Needed Appropriate flowmeter with nipple adapter Oxygen tubing HEART nebulizer Aerosol mask 40 inch length of smooth bore aerosol tubing

3 205.5 Continuous Nebulizer Treatment / Page 3 of 5 Procedure 1. Assemble equipment in the patient's room. 2. Secure the HEART nebulizer to an IV pole with tape. 3. Fill the nebulizer with the appropriate volume of Albuterol solution (see following chart ). 4. Fill the nebulizer with NS up to the 200 ml mark. Be careful not to fill past this mark because this will result in a more dilute solution and decrease the dose delivered per hour. A total volume of 200 ml should be mixed. The HEART nebulizer output is 50 ml per hour when set at a flow rate of 15 L/min, for a total treatment time of 4 hours (see following chart). Dose (mg / hr) Albuterol Solution (5 mg / ml) NS Total Volume 5 mg 4 ml (20 mg) 196 ml 200 ml 10 mg 8 ml (40 mg) 192 ml 200 ml 15 mg 12 ml (60 mg) 188 ml 200 ml 5. Set the flowmeter to 15 L/min. 6. Monitor the patient during the treatment. Assess the patient s pulse, respiratory rate, and other parameters once every hour. If any adverse side effects occur (see below), discontinue treatment immediately and notify the physician and document the event. 7. Use all of the medication. At the end of the treatment, disassemble and empty the residual solution out of the nebulizer and place in a clean area. The nebulizer is changed daily. Patient Assessment / Reassessment The patient s response to therapy should be assessed and reassessed. Patient assessment and reassessment should be performed according to the general RCS policy (see Section IV - Patient Assessment / Reassessment in the RCS Policy Manual). The need to continue therapy should be reassessed every 24 hours. Specific criteria for assessment and reassessment should include: Changes in breath sounds

4 205.5 Continuous Nebulizer Treatment / Page 4 of 5 Patient s tolerance to therapy Development of the following complications Complications Significant cardio-respiratory side effects such as tachycardia, increased or decreased blood pressure, and others must be corrected as soon as noted by stopping the treatment. Immediately stop treatment if any of the following occurs:. Heart rate <50 or >140 bpm Systolic BP <90 or >180 Respiratory Rate <10 or >24 Tremors Diaphoresis Any complaints of chest pain, palpitations, headache. Notify the physician and document the event. If cardiac arrest occurs, follow the procedure for resuscitation (Section 537 Resuscitation). House Formula Albuterol 10 mg per hour with normal saline nebulized continuously. This is equivalent to 4 Treatments Per Hour As Described in Section 205 Aerosolization Of Medications. Lack of Physician Orders In the event that physician orders are lacking, incomplete, or in error for whatever reason, no treatment shall be given. Every attempt must be made by the therapist to get either a written order. There are no exceptions. Discontinuation Procedures The same as for Section 100 Oxygen Therapy. The flowmeter is not disposable. Charting The same as for Section 100 Oxygen Therapy. Medications are to be charted on the Medication Administration Record in the ICCA or on the Cardiopulmonary and the Medication

5 205.5 Continuous Nebulizer Treatment / Page 5 of 5 Administration Check System (MAK). Medication, dosage, route of administration, times of administration, and initials of the therapist are to be included. The therapist's full name should be written at the very bottom of the Cardiopulmonary and Nursing flowsheet adjacent to the initials he/she will use when charting. All adverse outcomes must be charted in either ICCA or on the Cardiopulmonary Flowsheet.