Make your own free website on Tripod.com
Respiratory Care
Policy & Procedure Manual
Reviewed      page 1 of 4

Aerosol Therapy

1. Route: Aerosol Therapy refers to the aersolization of solution for inhalation via:
    1.1  Nebulizer
           1.1.1  face mask (section 5)
           1.1.2  in line in ventilator (section 6)
           1.1.3  bagged in with manual ventilator (section 7)

    1.2  Metered dose inhaler (MDI) with a spacer device..
           1.2.1  face mask (section 8)
           1.2.2  in line in ventilator (section 9)
           1.2.3  bagged in with manual ventilator (section 10)
 
2. Indications & Dosage
    2.1 Medications given by microneb, their indications, doses, methods of action, cautions and
          contraindications can be obtained in the NEOFAX manual,
          2.1.1 the most current version of which is permanantly kept in the Respiratory Lab in Equipment Manual Book #1.

3. Documentation
    3.1 All microneb & MDI treatments require a written physicians order.
 3.1.1 MDI orders shall specifty
  3.1.1.1 specific medication
  3.1.1.2 frequency of treatment
  3.1.1.3 number of puffs
  3.1.1.4 number of breaths per puff
 3.1.2 Micronebulizer orders shall specify:
  3.1.2.1 specific medication
  3.1.2.2 frequaency of treatment
  3.1.2.3 volume of medication (calculated in miligrams)
  3.1.2.4 volume of dilutant (saline, H2O, etc.)
    3.2 Adverse reactions to therapy will be reported to the physician & be documented in the permanant              record

    3.3 Respiratory Care Practitioners (RCPs) shall sign the medsheet for medications that they draw and              deliver. RCPs shall initial the medsheet for each dose delivered.

4. Responsibility for Delivery
    4.1 RCPs shall deliver all aerosolized medications to patients who are receiving positive pressure &/or            have an artificial airway.
5. Mask Nebulizer Treaments
    5.1 Equipment needed:
          5.1.1  Microneb unit
          5.1.2  O2 tubing
          5.1.3  O2 face mask
          5.1.4  O2 blender flowmeter or air flowmeter.
 

Brigham & Womenís Neonatal Respiratory Care
Policy & Procedure Manual
Reviewed      page 2 of 4

Aerosol Therapy
 
 

 5. Mask Nebulizer Treaments (ctd)
 5.2 Procedure:
          5.2.1. Place mask on top of nebulizer
          5.2.2. Attach O2 tubing to bottom of nebulizer and the other_end of tubing to the flowmeter of:
                    a selected FiO2 on_a blender or air flowmeter
          5.2.3. Add prescribed amount of medications to nebulizer.
          5.2.4. Turn flowmeter to 4-6 l/m.  Assure adequate mist_output.
          5.2.5. Place face mask on patient.  Monitor patient's heart_rate, etc. during treatment.
          5.2.6  After medication is nebulized, remove mask and turn_off flowmeter.
          5.2.7  Rinse nebulizer with sterile water.  Dry with sterile_gauze and return mask nebulizer to
                    patients equipment_bag.
 

6. Inline with Vent Nebulizer Treatments
    6.1 Equipment needed:
          6.1.1 Micronebulizer with O2 tubing, "T" (Intec) adapter, O2 blender or air flowmeter.
    6.2 Procedure:
          6.2.1. Place (Intec) T adapter on top of nebulizer.
          6.2.2. Attach on end of O2 tubing to the bottom of the_nebulizer and the other end to the                                      flowmeter  of a_blender with the prescribed FiO2 the patient is_ordered for.
          6.2.3. Fill nebulizer cup with prescribed medication.
          6.2.4. Insert nebulizer on the inspiratory side of the_ventilator circuit at the patient "Y".
          6.2.5. Turn the nebulizer's flowmeter to 4-6 l/m and assure_adequate mist output.
          6.2.6.  Immediately reduce the ventilator flow rate by the_same liter flow set on the nebulizer                                flowmeter.  The_peep and pip should remain constant before, during and_after the                                      treatment.  Monitor patient's heart rate, O2 saturation,etc. during treatment.
           6.2.7. When the medication has been nebulized, turn off the_nebulizer flowmeter and readjust                              ventilator flowmeter_to the pre-treatment liter flow.
           6.2.8. Remove nebulizer from patient's ventilator circuit and_rinse nebulizer with sterile water
                     and dry with_sterile gauze pad (2" x 2").  Return to patient's_equipment bag.
           6.2.9. Recheck ventilator pip and peep to assure prescribed_ventilator setting.
 

7. Med Neb Treatment via Manual Ventilator
 
    7.1 Equipment needed:
          7.1.1  rubber adapter
          7.1.2  metal Mapleson "T"
          7.1.3  trach swivel adapter
          7.1.4 manual ventilator  (checked).
 
 
 
 

Brigham & Womenís Neonatal Respiratory Care
Policy & Procedure Manual
Reviewed      page 3 of 4

Aerosol Therapy

7. Med Neb Treatment via Manual Ventilator (ctd.)

    7.2 Procedure:
          7.2.1. Obtain physician's order.
          7.2.2. Place Briggs adapter on top of neb and place rubber adapter at both ends, place metal "T" and
                    trach swivel at end of one rubber adapter.
          7.2.3. Place prescribed medication in med neb.
          7.2.4. Place O2 tubing on bottom of neb and attach to O2 source with equal Fio2 to manual                                 ventilator.
         7.2.5.  Attach med neb set up to elbow/pop-off of Mapleson (omit "T" for manometer here and use                      "T" in med neb set up to monitor patient pressure).  Attach trach swivel to ett if patient is
                   intubated.  Attach mask if patient is not intubated.
         7.2.6. Turn on med neb flow source to 4-6 lpm Turn down flow dependant manual ventilator flow                       source so that total flow does not exceed 8 lpm..  Check for adequate mist.
         7.2.7  Bag in med neb treatment as you would manually ventilate at patient. Long inspiratory time                      breaths are ideal.
         7.2.8. Monitor patient during treatment.  Observe closely for adverse reactions to therapy
         7.2.9. When treatment is completed, return patient to previous therapy (or room air).
         7.2.10.Rinse med neb with sterile water and store in patient set up bag.
 

8. Mask MDI/Spacer Treaments
    8.1 Equipment needed:
          8.1.1  metered dose cartridge per MD order
          8.1.2  spacer with proper mask fit per NEWBORN RESUSCITATION standards.
          8.1.3  manual ventilator on standby
          8.1.4  O2 suppliment to sustain O2 saturation
    8.2 Procedure:
          8.2.1  Obtain a physicians order for:
                    8.2.1.1  Specific medication
                    8.2.1.2  Number off actuations (puffs)
                    8.2.1.3  Number of patient breaths or manual ventilations per actuation
          8.2.2  Shake the MDI cartridge
          8.2.3  Place the cartridge in the spacerís holding chamber
          8.2.4  Actuate the cardridge
          8.2.5  Apply the mask to the face
          8.2.6  Assure proper number of breaths (common range 5-10)
          8.2.7  Monitor patient's heart rate, etc. during treatment.
          8.2.8  Repeat as ordered, as tolerated
          8.2.9  return mask nebulizer to patients equipment bag.
 
 
 
 
 

Brigham & Womenís Neonatal Respiratory Care
Policy & Procedure Manual
Reviewed      page 1 of 4

Aerosol Therapy

  9. Inline with Mechanical Ventilator MDI Treatment
      9.1  Equipment needed:
 9.1.1   MDI, spacer & connections for ventilator (15mmI.D.) & airway (15mm O.D.)
            9.1.1.1   Assure that spacer is labeled with date placed in service & date < wk. old.
      9.2   Procedure:
 9.2.1   Place spacer betweem the ventilator circuit and the endotracheal tube
 9.2.2   Select and MDI cartridge and shake vigorously
 9.2.3   Attach MDI cartridge to spacer and actuate.
            9.2.3.1   Wait 30 seconds before repeating actuation of that cartridge
 9.2.4   Assure that the prescribed number of breaths are delivered throught the spacer.
 9.2.5   The PEEP and PIP should remain constant before, during and after the tx.
 9.2.6    Monitor the patientís heart rate O2 sat. etc. before, during & after tx.
 9.2.7    Remove spacer from in-line without creating back & forth movement of the ETT.
 9.2.8    Place spacer in clean equipment bag
]
10. Med Neb Treatment via Manual Ventilator
     10.1 Equipment needed:
             10.1.1  metered dose cartridge per MD order
             10.1.2  spacer with proper mask fit per NEWBORN RESUSCITATION standards.
                        10.1.2.1  Use spacer with no one-way-valves when  manual ventilation is necessary.
             10.1.3  flow inflating manual ventilator for spacer with no valves if O2 suppliment or positive
                         pressure required
             10.1.4  O2 suppliment to sustain O2 saturation
    10.2  Procedure:
             10.2.1  Obtain a physicians order for:
                        10.2.1.1  Specific medication
                        10.2.1.2  Number off actuations (puffs)
                        10.2.1.3  Number of patient breaths or manual ventilations per actuation
             10.2.2   Setup
                        10.2.2.1  Place spacer between airway and manual ventilator
                        10.2.2.2. Shake the MDI cartridge
.            10.2.3  Place the cartridge in the spacerís holding chamber
             10.2.4  Actuate the cardridge
             10.2.5  Attach ett if patient is intubated.  Attach mask if patient is not intubated.
             10.2.6  Assure proper number of breaths (common range 5-10) flow dependant manual ventilator                          flow source so that total flow does not exceed 8 lpm..
            10.2.7   Bag in med neb treatment as you would manually ventilate at patient. Long inspiratory time breaths are ideal.  Limit number of breaths per order
            10.2.8   Monitor patient during treatment.  Observe closely for adverse reactions to therapy
            10.2.9   Repeat as ordered, as tolerated
            10.2.10 When treatment is completed, return patient to previous therapy (or room air).