Cardiopulmonary Services
General Procedures
Proc. 7.5
Aerosolized Pentamidine
Purpose:
To provide standards for administering aerosolized pentamidine for prophylaxis
treatment of pneumocystis carini pneumonia.
Description:
Pentamidine an antiprotozal agent, is a sterile, white crystaline powder soluble in
water, after reconstruction it is administered by inhalation via the Respigard II or
similar filtered aerosol nebulizer.
Indications:
Monthly treatment with aerosolized Pentamidine is indicated for the prevention of
pneumocystis carini pneumonia in high risk HIV infected patients or
immunosuppressed patients such as bone marrow transplant patients.
Contraindications/Hazards/Complications:
1. Pentamidine is contraindicated in patients with a history of an anaphylactic
reaction to inhaled or parenteral pentamidine isethionate.
2. May induce bronchospasm or persistent cough. (Treat with a unit dose of
albuterol inhalation if indicated).
3. Bitter taste of pentamidine. (May be relieved by water or hard candy).
4. Nausea. (Stop treatment as necessary for patient toleration).
Equipment:
1. Respigard II or similar hand-held nebulizer with non-rebreathing valve and
expiratory filter.
2. 10cc syringe
3. 19 gauge needle
4. 20cc bottle of sterile water
5. 300mg bottle powdered pentamidine (obtain from pharmacy using standard
request form).
6. submicron filter mask, gloves
7. small bore oxygen tubing
8. tissues, sputum specimen cup
9. compressed air source, air flowmeter.
Personnel:
1. Respiratory Care Practitioners; Respiratory Therapy Technician I and II,
Respiratory Therapist I and II
2. Registered Pulmonary Function Technician
Certified Pulmonary Function Technician
Procedure:
1. Identify self and department.
2. Identify patient by comparing hospital and billing numbers on the armband to
those on the physicians’ orders for therapy.
3. Turn on the fan motor of the Emerson isolation chamber 5 minutes prior to
treatment to allow air to begin circulating through the chamber. Note: The LOW
PRESSURE ALARM will sound until the fan comes up to speed. If the alarm
does not stop, ensure that all filters are in place. If the alarm persists, consult the
Owner’s Manual.
4. If the chamber is inoperative, give treatment using conventional method. Wear
Cardiopulmonary Services
General Procedures
Proc. 7.5
mask throughout treatment even though nebulizer is filtered. Ensure patient
breathes in and out through their mouth to ensure optimum filter efficacy.
5. Mix 6 cc of sterile water with 300 milligrams pentamidine. Allow
pentamidine powder to dissolve completely before filling the nebulizer.
6. Fill nebulizer with all 6 milliliters of the solution.
7. Run small bore tubing from compressed air source to inlet on outside of chamber.
8. Assess patient as per department policy for giving hand-held nebulizer (HHN)
treatments.
9. Have patient sit in chamber. Instruct patient to breathe in and out through their
mouth. This will insure optimum efficiency of the filtered HHN.
10. Close chamber. Ensure tight seal on door by verifying that LOW PRESSURE
ALARM stops after door is closed.
11. Adjust compressed air source to 7 LPM flowrate and begin aerosolizing
medication.
12. Stop the treatment at the halfway point or approximately 10 minutes. Allow the
chamber fan to run for 3 minutes to allow any aerosol residue to be filtered.
13. Assess patient’s breath sounds and heart rate for any adverse effects of the
medication.
14. If the patient has no adverse effects, continue treatment.
15. After the treatment has been completed, allow the chamber fan to run for 3
minutes to allow any aerosol residue to be filtered and open the chamber door.
16. Assess patient’s breath sounds and heart rate for any adverse effects of the
medication.
17. Dispose of all materials in appropriate containers and wipe down all surfaces with
aseptic cleaner.
18. Age appropriate considerations include assessing the patient’s ability to
cooperate with the procedure.
Infection Control:
1. Standard universal precautions shall be observed at all times.
2. Dispose of all materials in appropriate waste container.
3. Dispose of all needles, glass, and metal in an approved sharps disposal
container.
4. Wipe down all surfaces inside chamber with A-500 or equivalent viracidal
cleaner.
References:
1. AARC Clinical Practice Guidelines
2. Emerson, Aerosol Administration Booth operators manual
3. LSUMC Infection Control Committee
Written: April 1993
Revised: April 1997
December 1997
Reviewed: April 1998
Reviewed: August 2000
Revised: March 2003