NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5330

POLICIES AND PROCEDURES

Subject: Medical Direction

Aerosol Therapy with Small Volume Nebulizer

Associated Policies: 5329, 5411, 6529, 6530 02/05/98

  1. Indications:
  1. Refer to indications of specific medication to be nebulized.
  1. Therapeutic Effects:
  1. Administration of aerosolized solution and medications to the respiratory system.
  1. Contraindications:
  1. Absolute- refer to specific medication to be administered.
  2. Relative- refer to specific medication to be administered.
  1. Adverse Effects:
  1. Suppression of respiratory drive in patients with COPD.
  2. Refer to specific medication to be administered.
  1. Equipment:
  1. One (1) small volume nebulizer, Puritan Bennett #0001140 or equivalent.
  2. One (1) 3 cc syringe with needle or vial access device.
  3. One (1) 5-10 cc vial of normal saline (if pre-mixed solution is not available).
  4. Oxygen source.
  5. Medication (pre-mixed with normal saline if available).
  6. Oxygen mask and/or mouth piece.
  1. Procedure:
  1. Assemble required equipment. Select an appropriate patient/appliance interface (mask or mouth piece). Connect to oxygen source.
  2. Position patient high fowlers, if tolerated.
  3. Place small child or infant on caregiver’s lap.
  4. Explain procedure to the adult or teenage patient.
  5. For child, explain how treatment is being given, not why.
  6. Add appropriate dose of medication and volume of solution to the nebulizer.
  7. Adjust oxygen flow meter to deliver 7-10 liters per minute to the nebulizer.
  8. If patient can cooperate deliver nebulized bronchodilator through mouthpiece.
  9. Instruct the patient to inspire fully, briefly hold his/her breath, passively exhale, and pause before the next inhalation.
  10. Continue procedure until the medication has been depleted
  11. If child or patient is unable to cooperate or is hypoxic and cannot assist, bronchodilator can be administered via aerosol mask, or
  12. "Piggy back" nebulizer with mouth piece into side of oxygen mask and tape into place.
  13. In event of BVM use, the small volume nebulizer can be adapted to fit between mask and bag to administer aerosol medications via positive pressure.
  14. Following treatment, encourage the patient to cough.
  1. Special Information
  1. Monitor patient for signs of respiratory depression.
  2. Use nebulizer in addition to oxygen therapy, not instead of.
  3. If available, use pulse oximetry as adjunct to small volume nebulizer.
  4. Medications and solutions that can be administered via small volume nebulizer:
  1. Albuterol sulfate.
  2. Metaproterenol sulfate.
  3. Epinephrine.
  4. Normal Saline.