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Nebulisation

Nebulisation

This section deals with nebulisers; compatibilities of commonly used nebulised solutions; using the lung function laboratory and clinical use of individual tests.


General information

  •  Use sodium chloride 0.9% for injections as diluent.
    • water will result in a hypotonic solution which may cause broncho-constriction
  • A final volume of 4-5 ml is optimal 
  • All nebulisers have a "dead" volume, i.e. that volume which is not available for nebulisation, usually 1 ml 
    • if only 1 ml of drug solution is put into the nebuliser, very little of the drug is released
    • the more the solution is diluted, the greater the fraction of drug released and received by the patient
  • However, the volume used is limited by the length of administration time
  • Use a flow rate of 6-8 l/min
    • this delivers particles of a size to adequately penetrate to the small airways and so ensure effectiveness of treatment
  • Oxygen usually used as the driving gas in patients who are young and have asthma
  • Air used as the driving gas in patients who have COPD and evidence of C02 retention
  • Choice can be made on the basis of arterial blood gas measurements
  • Tap the wall of the nebuliser when it begins to 'fizz"
    • large droplets tend to stick to the sides of the nebuliser 
    • tapping the nebuliser wall makes them available for nebulisation
  • Use one nebuliser per patient and change nebuliser and tubing daily   

Compatibilities of commonly used nebulised solutions

 

 

SALB TERB IPRA
SALButamol - X C
TERButaline  X  -  C
IPRAtropium  C  C -

 

 

 

 

 

C = Compatible. Ensure solutions are mixed immediately prior to use. If the resultant solution goes cloudy, or if there is a precipitate, it should be discarded.

X = Not applicable/solutions not normally prescribed together