Nebuliser Therapy
What is it?

A nebuliser is a small device that converts a drug from
solution into an aerosol using a compressor or
compressed gas.

Nebulisation creates a mist of drug that is inhaled via a
face mask or mouthpiece.
How does it work?

A flow of gas passes through a very small hole
(venturi).

Rapid expansion of air causes a negative pressure
that sucks the nebulised fluid up the feeding tube
system.

The fluid is then atomised and inhaled.
How much reaches the lungs?

12% of the nebulised solution reaches the lungs.

This is why nebulised doses of drugs are higher than those given by inhaler.
Indications

Bronchodilator/anticholinergic for patient with acute exacerbation of asthma/COPD.

Bronchodilator/anticholinergic drug regularly to a patient with severe asthma or
reversible airway obstruction in whom regular high doses have been shown to be
beneficial.

Prophylactic medication to a patient who has difficulty using inhalers.

Antibiotic to a patient with a chronic purulent chest infection.

Pentamidine for prophylaxis and treatment of pneumocystis pneumonia.
Please ensure you refer to local policy before undertaking any procedure
Oxygen or Air?
•
Acutely ill – Use oxygen 6/8 L/min
•
Acute asthma - Use oxygen 6/8 L/min
•
COPD – Use air unless acutely unwell and already
receiving oxygen

Routine nebulisers patient otherwise well and not on
oxygen use air
Cautions
•
Patients with glaucoma receiving anticholinergic drugs
e.g. ipratropium bromide should use a mouthpiece to
reduce leakage of nebulised solution into the eyes
Further information is available from:
British Lung Foundation (2004) Nebulisers. Available from [online]
<http://www.lunguk.org/nebulisers.asp?diag=11> Accessed 27/06/06
British Medical Association/Royal Pharmaceutical Society of Great Britain
(2007) British National Formulary 53. London: BMJ Publishing
Please ensure you refer to local policy before undertaking any procedure
Name……………………………………………………….WMS No………………………..
T- DOCS: Nebuliser use
Please can you give a nebuliser to this patient / manikin?
Washes Hands
Understands indications &
anatomy
Obtains informed consent
Explanation to patient, often
including complications
Communication skills
Appropriate preparation
Appropriate analgesia
Technical ability especially with
any special equipment and
sharps
Aseptic technique
Seeks help as appropriate
Post procedure management
Professionalism
Overall ability to perform
procedure
Overall Grade
Hand wash with water and soap and alcohol gel
using the Ayliffe technique.
Explains benefits and side effects of nebuliser therapy.
Explain that a nebuliser converts a drug solution into an
aerosol for inhalation.
Main indications: acute exacerbation or regular
treatment in asthma or COPD. Can be used to deliver
different drugs.
Introduction and identifies patient.
Obtains informed consent
Clear explanation: e.g. “I am going to give you treatment
for your breathing using this nebuliser”
Assessment throughout the procedure and encourages
patient to ask questions.
If required records peak flow prior to procedure
Chooses nebuliser device with appropriate face mask or
mouth piece.
Chooses air or oxygen, depending on clinical case.
Ensures drug is prescribed to be given by nebuliser
Ensures correct drug is given to correct patient
Chooses appropriate mask, fixes appropriate tubing to
the nebuliser mask and ensures that 6-8 litres of gas per
minute are used for delivery.
Advises patient to breath through their mouth and not
talk.
Asks the patient to tap the nebuliser chamber every few
minutes to prevent condensation.
This is a clean technique
Considers complications e.g. tachycardia and headache
with Salbutamol, dry airways with Ipratropium bromide.
Seeks help if needed.
Ensures mask is removed when chamber is empty and
chamber is washed and left to dry
Records peak flow again at appropriate intervals
Documents in patients notes
Communicates with patient re: procedure and need for
nebuliser.
Encourages patient to ask questions.
Thanks patient.
Assess globally, would you be happy for this student to
give a nebuliser to a patient with direct supervision ?
BE
B
S
AE
Please ensure you refer to local policy before undertaking any procedure
T-DOCS:
For Medical Students
Clinical Skill ……………………………..
Name of Student
Areas of good practice
1.
2.
3.
Areas for improvement
1.
2.
3.
Below Expectation
Skills labs
Supervised
Job Title
Global assessment:
Borderline
Satisfactory
Skills labs
Unsupervised
Name
Please print:
Patient Safe
Supervised
Assessor signature:
Date
Above Expectation
Teaching Potential
Signature
How suitable do you think this assessment is for undergraduate medical students?
Not Suitable
Highly Suitable
1
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2
3
4
5
6
7
8
9
Any other Comments: Free text please use!
10
Please ensure you refer to local policy before undertaking any procedure