# Nebulisation

## Overview

This module describes how to use a nebuliser mask to deliver medications directly to the lungs of patients with respiratory conditions.

## Indications

Nebulised medication is usually delivered to:

1. Patients with an acute asthma/COPD exacerbation

2. Asthmatics or patients with COPD who struggle to use another medication delivery mechanism

3. Patients with chronic purulent lung infections

4. Children with croup (laryngotracheobronchitis)

5. Children with bronchiolitis

## Contraindications

1. Some medications delivered via nebuliser have their own contraindications

## Patient information and consent

### How do I explain this procedure?

“I need to give you some medication directly into your lungs. I will put a mask on your face that is connected to oxygen and will allow you to breathe in the medication in the form of a mist.”

### What can my patient expect?

“The mask can sometimes make you feel a bit claustrophobic, and you may smell the medication, but you will be able to breathe freely.”

### What is my patient’s role?

“Let me know if you have any allergies. Sit upright and take deep breaths. Do not remove the mask from your face until the medication has stopped making mist.”

## Preparation

###

### Documentation

1. Prescription chart

2. Patient notes

### Equipment

1. Alcohol-based hand rub

2. Nebuliser mask and tubing

3. Medications for nebulisation

4. Syringe and aspiration needle (ideally blunt fill)

5. Alcohol swab

## Site & Positioning

Ask the patient to sit upright or recline slightly.

## Procedure

Follow medical asepsis without gloves.

1. Perform hand hygiene.

2. Attach the tubing to the nebuliser chamber. Unscrew the chamber.

3. Attach the blunt fill needle to the syringe. Use the alcohol swab to clean the tops of vials of medication being used. Draw up the required dosage of medication.

4. Inject the medication into the chamber and close the chamber. Attach it to the mask.

5. Attach the tubing to the oxygen point and turn the oxygen on to 6-8L per minute.

6. Place the mask on the patient’s face.

7. Record administration of the nebuliser in patient notes and on the prescription chart.

## Troubleshooting

I'm unsure how to prepare salbutamol and ipratropium bromide for nebulisation.

Use 5 mg of salbutamol (1 ml of 5 mg/ml solution) for adults or 0.3 mg/kg to a max of 5 mg for children. If you’re adding ipratropium bromide, add 0.5 mg for adults or 0.25 mg for children (0.5-1 ml of 0.25 mg/ml solution). Dilute with normal saline up to a final volume of 4-5 ml for adults or 2-3 ml in children.

## Risks

1. Healthcare personnel exposure to infectious aerosols

2. Some nebulised medications have side-effects such as dizziness

## References

1. Jevon P, Humphrey M. Respiratory procedures: Use of a nebuliser. Nursing Times. 2007;103(34):24. Available from: https://www.nursingtimes.net/clinical-archive/respiratory-clinical-archive/respiratory-procedures-use-of-a-nebuliser-21-10-2007/