RT Clinic : Basics of Nebulizer Therapy

Summary

In this RT clinic video, the host demonstrates how to administer nebulizer treatments using a standard nebulizer setup. Key points include assembling the device, adjusting the flow meter to 8 liters per minute, and ensuring at least 3 milliliters of medication for optimal particle size. The video also emphasizes proper breathing techniques, the importance of using a mouthpiece over a mask for better medication delivery, and tips for maintaining nebulizer efficiency. Additionally, a tower nebulizer is introduced for higher dosage treatments, highlighting its benefits for asthmatic patients.

Takeaways

• 🌟 Standard nebulizer treatments are demonstrated, including the setup and use of a generic nebulizer.
• 💊 The importance of using at least 3 milliliters of volume for nebulizer medication is emphasized, with a recommendation not to exceed 6 milliliters.
• 🔍 Nebulized medication is described as having a particle size of 3 to 5 microns, which is crucial for reaching the lower respiratory tract.
• 👃 Breathing through the mouth is crucial during nebulizer treatment, as breathing through the nose can reduce the effectiveness of the treatment.
• 👁️‍🗨️ The script highlights the need to observe chest excursion and nebulizer medication flow to ensure proper treatment administration.
• 🛑 It's advised to stop the nebulizer treatment when it starts to 'sputter,' indicating that the medication particle size is no longer optimal.
• 🚫 The script discourages the use of 'blow-by' treatments due to their reduced effectiveness in delivering medication.
• 💧 A tip is provided to pre-wet new nebulizers with saline to ensure consistent treatment times.
• 🌡️ The script mentions the use of medical air instead of oxygen for nebulizer treatments to avoid affecting blood gas levels.
• 👩‍⚕️ The benefits of using a mouthpiece over a mask are discussed, with a focus on patient engagement and the delivery of larger medication doses.

Q & A

What is the purpose of a nebulizer?

A nebulizer is used to deliver medication in the form of a fine mist inhaled into the lungs. It's particularly helpful for patients with respiratory conditions like asthma or COPD.

What is the significance of the baffle in a nebulizer?

The baffle inside a nebulizer helps to break up the medication into small particle sizes, which is crucial for the medication to reach the lower airways effectively.

Why is it important to use at least 3 milliliters of volume when administering nebulizer medication?

Using at least 3 milliliters ensures that the medication is properly nebulized and that the particle size remains within the optimal range of 3 to 5 microns for effective delivery to the lungs.

What is the recommended flow rate for most nebulizer treatments?

The recommended flow rate for most nebulizer treatments is eight liters per minute, although some home compressors might run at a slightly lower rate.

Why is it not advisable to use a nebulizer with less than 3 milliliters or more than 6 milliliters of medication?

Using less than 3 milliliters may result in inadequate medication delivery, while using more than 6 milliliters can affect the particle size and potentially reduce the effectiveness of the treatment.

What is the purpose of the reservoir in a nebulizer system?

The reservoir in a nebulizer system allows the patient to inhale a larger amount of medication with each breath, enhancing the efficiency of the treatment.

Why is it important for patients to breathe through their mouth and not their nose when using a nebulizer?

Breathing through the mouth ensures that the nebulized medication is inhaled effectively into the lungs. Breathing through the nose can lead to the medication not being inhaled properly and reduces the treatment's effectiveness.

What is the significance of the 'sputtering' sound in a nebulizer?

The 'sputtering' sound indicates that the nebulizer is running out of medication and the particle size is no longer optimal. It's a signal that the treatment should be stopped.

What is the difference between using a mouthpiece and a mask for nebulizer treatments?

A mouthpiece requires the patient to take an active role in their breathing, which can lead to better medication delivery. A mask can be more comfortable but may not encourage deep breaths as effectively, potentially reducing the treatment's effectiveness.

Why is the 'blow-by' treatment method not recommended?

The 'blow-by' method decreases the amount of medication delivered to the patient and is less effective than using a mouthpiece or mask. It's generally not recommended for optimal medication delivery.

Outlines

00:00

🌫️ Introduction to Nebulizer Treatment

The speaker begins by introducing the topic of nebulizer treatment, focusing on the proper use of nebulizers for delivering medication. The video aims to educate viewers on the standard nebulizer setup, including the nebulizer itself, baffle, mouthpiece, and tubing. The importance of using the correct volume of medication (at least 3 milliliters) is emphasized to ensure optimal particle size for effective treatment. The speaker demonstrates how to assemble the nebulizer and prepare it for use, highlighting the need for a smooth laminar flow during inhalation.

05:03

🌬️ Nebulizer Technique and Assessment

This paragraph delves into the proper technique for using a nebulizer, with the speaker instructing patients to breathe normally and take deep breaths every four to five breaths. The importance of observing chest excursion and ensuring medication is being inhaled through the mouth, not the nose, is discussed. The speaker also addresses the issue of patients falling asleep during treatment and the need to wake them to maintain proper inhalation. Additionally, the speaker explains how to recognize when the nebulizer is running out of medication by listening for a change in sound, indicating that the treatment should be stopped.

10:05

💨 Nebulizer Maintenance and Alternatives

The speaker discusses the importance of nebulizer maintenance, emphasizing the need to empty any remaining medication after use to prevent it from affecting the next treatment. A technique for 'wetting' a new nebulizer is shared to ensure consistent treatment times. The paragraph also touches on the use of an alternative nebulizer design, known as a tower nebulizer, which is used for delivering higher doses of medication more quickly. The speaker demonstrates how to prepare and use this type of nebulizer, highlighting its benefits for patients requiring larger doses.

15:07

🚫 Discouraging Blow-By Treatments

In this paragraph, the speaker strongly advises against the use of blow-by treatments, which involve holding the nebulizer near the patient's face without a mouthpiece or mask. This method is criticized for delivering less medication effectively. The speaker also shares a personal trick for ensuring consistent nebulizer performance by 'wetting' new nebulizers with saline before use. The video concludes with a demonstration of the tower nebulizer in action, emphasizing its efficiency in delivering large doses of medication and the speaker's preference for mouthpieces over masks for better medication delivery.

Keywords

💡Nebulizer

A nebulizer is a medical device that administers medication in the form of a mist inhaled into the lungs. In the video, the speaker explains how to use a standard nebulizer for delivering medication, emphasizing the importance of the device in respiratory therapy. The nebulizer is central to the video's theme of educating viewers on the correct administration of nebulizer treatments.

💡Medication

Medication refers to the substances used to treat or prevent diseases. In the context of the video, the speaker discusses the process of adding medication to the nebulizer and ensuring the correct volume for effective treatment. The video aims to educate on the proper use of nebulizers for medication delivery, which is crucial for patients with respiratory conditions.

💡Particle size

Particle size is a critical factor in nebulizer therapy, as it determines how deep into the lungs the medication can reach. The video specifies that the ideal particle size for nebulized medication is three to five microns, which allows the medication to reach the lower airways effectively. This concept is essential for understanding the technical aspects of nebulizer treatment.

💡Baffle

The baffle is a component within the nebulizer that helps to break up the medication into smaller particles. The script mentions that the baffle is located inside the nebulizer and plays a role in the nebulization process. Understanding the function of the baffle is important for grasping how the nebulizer operates.

💡Flow meter

A flow meter is a device that measures the rate of fluid flow. In the video, the speaker discusses setting the flow meter to a specific rate, which is crucial for the proper functioning of the nebulizer. The flow meter is integral to ensuring that the medication is nebulized at the correct rate for patient use.

💡Reservoir

The reservoir is a part of the nebulizer system that holds the medication. As explained in the video, it allows the patient to inhale a larger amount of medication with each breath. The reservoir is highlighted as an important component that enhances the efficiency of medication delivery.

💡Breathing pattern

Breathing pattern refers to the rhythm and depth of a person's breaths. The video instructs patients on the correct breathing pattern to use while receiving nebulizer treatment, which is essential for ensuring that the medication reaches the intended areas of the lungs.

💡Assessment

Assessment in this context refers to the process of monitoring and evaluating a patient's response to nebulizer treatment. The video mentions assessing patients while they are receiving treatment, which is a critical part of ensuring the treatment's effectiveness and the patient's comfort.

💡Compressed air

Compressed air is air that has been pressurized and is used to power the nebulizer. The script discusses using compressed oxygen or medical air to run the nebulizer, which is important for the efficiency and effectiveness of the treatment. Understanding the use of compressed air is key to grasping how the nebulizer operates.

💡Mask

A mask is an alternative method of administering nebulizer treatment, where the mist is inhaled through a facial mask rather than a mouthpiece. The video discusses the use of masks and compares them to mouthpieces, suggesting that mouthpieces are preferable for certain treatments due to their effectiveness.

Highlights

Introduction to delivering nebulizer medications

Explanation of the standard nebulizer setup

Importance of the baffle in the nebulizer

Proper attachment of the mouthpiece and avoiding contamination

Functionality of the reservoir in the nebulizer

Setting up the flow meter for optimal nebulizer performance

Minimum and maximum volume requirements for nebulizer medication

Demonstration of adding medication to the nebulizer

Importance of particle size in nebulized medication

Correct breathing technique for patients using a nebulizer

Assessment tips while observing a patient on a nebulizer

How to identify when the nebulizer treatment is complete

Differences between mouthpiece and mask usage for nebulizer treatments

Advantages of using a mouthpiece over a mask

Contraindications and concerns with blow-by treatments

Cleaning and maintenance tips for nebulizers

Use of a 'wet' nebulizer for consistent treatment times

Introduction to the tower nebulizer for higher dosages

Demonstration of the tower nebulizer setup and usage

Conclusion and call to action for feedback and questions

Transcripts

what's up today guys welcome back to the

RT clinic today I'm talking about

delivering nebulizer medications now

question is have you ever seen anybody

take their net like this

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cut to the intro

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we are gonna show today how to give a

standard nebulizer treatment we call

this a tena it can be called whatever

but this is your standard generic

nebulizer so we're gonna I'm going to

show you a little bit of how with

medication in they teach the patient

their breathing pattern and then some

parts of your assessment while you're

watching them take the nebulizer and

then after so let's get to it there are

some basic pieces to a nebulizer first

of course you're going to have the

nebulizer inside of it as you take off

the top you see there's going to be a

baffle in here and so what that's going

to do is actually going to come through

this side or air in your case if you're

at home it's going to come through it's

going to cause splattering the

medication it's going to break it up in

a really small particle size we don't

like to call it smoke we don't want to

call it mist we call it nebulized

medication because that's exactly what

it is so let me attach that to the next

piece extremely simple this is a tea as

you can see it goes right on the top

we then attach the mouthpiece of course

when I'm attaching the mouthpiece for

the patient I make sure I don't touch

this part that's gonna be in the

Roundhouse my girls and like to be

courteous to them so that this piece

would go on here so I usually in case

the patient I would just use the bag put

that on and then we have this piece here

so you may see a lot of nebulizers that

just look like this this is our

reservoir so I'm going to talk a little

about what this is used for but I like

to use it because it does allow them to

get a larger amount of nebulizer

medication each time they take a breath

in and then our simple oxygen tubing

that connects the bottom and runs to the

flow meter

there's a standard setup so mouthpiece

here we have our nebulizer our tea and

then our extra piece of tubing or risk

for two so

at the Texas is a flow meter so this

necklace right front this is

specifically from Salter and they're all

very very similar this is just what we

use our facility

this has to have at least and / the /

the

the guidelines this is supposed to have

four liters at least that's that's super

low so what you're gonna want to run

most your nebulizers on is eight liters

per minute okay if you have a home

compressor you turn it on that's really

when it's running on maybe a little bit

lower and put it in the hospital

we're running enough oxygen in this case

and we could run top medical air

actually medical air is does really well

because it's not gonna mess with our

pao2 on their blood gas it's not gonna

give them extra supplemental oxygen if

they do I need it and especially on our

Neos our peds we use air in this case

I'm just going to do with oxygen so I

would turn this up to six liters you can

hear it running through there but

there's no nebulizer medications so shut

that off to add nebulized medication to

it we just simply take off this part now

we're going to add it into here the

absolute key is that when you run

medication in these is that you have at

least three milliliters of volume

whatever you're doing do not put a

milliliter two million at least three

milliliters and I wouldn't go more than

six in most cases because what it's

going to affect this particle size and

we're going to talk about particle size

a little bit so we have our 5 ml

normal saline bullet we'll put about 3

in there

there we go

we're going to attach this piece to the

top and then we're gonna start it up hey

there four minutes now you hear it

nebulizing

so in this case you can see the

nebulized

medication is saline in this in this

part coming out this side and coming out

this side this is not

normal this is not cool at all this is a

rink temperature so it doesn't really

have much of a temperature to it but as

you can see it's coming out both sides

now the key is the service put this in

their mouth and breathe it in I'm going

to show you a couple key things to look

for when they do that so when I hand

this to a patient what I'll do is I'll

ask them bike down the mouthpiece and I

ask him to breathe normal and then every

four to five breaths take a breath in

and then let it out the real key is that

they have a smooth laminar flow and are

taking their treatment because we want

to get it down to the lower purse to

Airways now this is not a mist wherever

this is not not based nothing like that

these the nebulizer medication and this

particle size is three to five microns

that's really important because that's

exactly what it takes to get to those

areas right above your IV line where it

can fly into those muscles and loosen

them up and that's what most of them

well that is what all our bronchodilator

students so if I hand this up patient

this is the normal breathing pattern so

I have that like this right now

notice a couple of things with this

first of all when I breathe in and

you're gonna see the mist go in when I

breathe out you should see it shoot out

quickly when I take the breath in this

reservoir works because I'm not only

going to get the medication from here

I'm gonna get nebulized medication

that's held in here as you can imagine

we would get less in this case

because I do not have the reservoir on

so actually kind of lied to get more

medication which is great

one thing you might also want to cut

your patients with and tell me if you

can figure out what the problem is here

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the respiratory therapist out there

probably picking up on pretty quick

watch the nebulizer medication here some

patients she'll hand this to them

they'll put it in their mouth and

they'll do this breathe through their

nose

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you see how this isn't moving at the end

watch when I breathe through my mouth

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one the key is that I always look for

especially to confuse patients when you

do that teaching to stay there with them

and your watch them chest rise like like

chest excursion so my eyes always goes

for chest excursion and then I look at

to see if they're pulling actually

nebulized medication from the end of

their pants so that's really important

to know that they're taking it right if

they start to fall asleep sometimes well

you want to make sure they're wake him

up of course they may start breathing

into their heads

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getting zero minutes at that time

because they're pulling air from the

nose down the whole pharynx and not

pulling anything is anything from the

nebulizer

now you're gonna hear as this thing's

running hearing hearing a change in the

sound

you're the change in the sound it's

called so many different things call it

sputtering

it's really running out of medication is

what it is now

once you start to hear sputter these

particle sizes are no longer three to

five microns and you should stop the

nebulizer

technically that's exactly what you

should do now though there are a lot of

patients and we're in customer service

so a lot of patients that will say

there's still some medication in there

and I want you to

tap it you

can tap it a knock some of the

medication off the sides and then be

they can get one or two extra breaths

out of work start sputtering against

that makes the patient happy I go with

it but technically when it starts to

sputter the treatment is finished and

then take really long because I'm using

the compressed oxygen off the wall but

it's still running eight leaders so

what's the more medication there

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so we're running again you can hear the

change in sound and if I get it closer

you hear that change really nice smooth

you can see on the bottom here you see

the nebulized ceiling

see it come out see it on my blue shirt

there

you can see that we have coming out well

there if we include this side that's all

the nebulizer medication coming out so

there are also a big

controversy a lot of people you go in

the room and they say I don't wanna do

that TV

the last therapists let me do the mask

so the mask is this it's an aerosol mask

let me talk about it a little bit

not a big fan personally the aerosol

mask because I like to deliver much of

the medication as I can because if I'm

in the room giving the treatment I

wanted to get the medication and aerosol

mask works like this it goes all in the

patient

and when they take a breath in

they get medication

I'm gonna be a lot quicker then get some

medication from this but what it does

not encourage them to do is to take

those specific threat especially the

deep breath because a lot of times

they'll put this on patient and they're

gonna do this

so they're gonna fall asleep and they're

gonna have to get the medication their

way in sure so I strongly recommend

there are definitely times to use a mask

but it's a very very rare I encourage

the patient each time I would really

like I tell them I'd really like you to

try to use the t piece for this

treatment

absolutely during the day too because

what it does it makes them take an

active role in their breathing when

they're taking the medication

being more deliberate about it and I

totally believe it delivers way more

medication so that's the use of the

standard manual Iser I

can't really think of much else I need

to go over with this thing

you know there is

there has been done before which is

definitely not encouraged blow-by

treatments now I'll give you an idea

what blow-by treatment is you'll hear

this they're heard of this give total

before so what we would do is we would

include one side and maybe this would be

a crying in for something and the rest

right there so hold these treatments

and if you have one of your really young

young ones there obligate those

breathers don't point their mouth make

sure you point their nose

cuz we're gonna take it in their nose

and we would kind of instead of using

the bass we would we'll do this now you

decrease your appendix and deliveries by

I come now you make a number of but it's

you decrease a lot so you're not

delivering quite as much medication so

blow-by is definitely not recommended

although you can see when I'm talking

and I take a breath in it just almost

makes this area like a little bit of

reservoir so I can take it in that's

what a blow by treatment is so if you

have if you have a young one and you

have to do it make sure you're aiming

up look at those breathers

don't even around him right there right

there below their nose and that's where

I try to keep the mist if I have to do

it but really try not to

done with your treatment there are some

other things you need to look at so

let's say anything has tappet or

whatever but you see there's still some

medication in there and every time you

give medication there's gonna be some of

it that's not going to be nebulizing so

it's just not gonna break up the way it

should what we need to do is make sure

that is out of the nebulizer and not

built into the next treatment because it

will just stay in there and they'll be

more unnavigable medication and more and

more and more so we raise out that we're

is out these or what we especially if

nothing else you just dump out that name

is medication that's not being here so a

lot of times we can shut this off

open it up like this and with a gloved

hand you could dump out that over a

trash bag or something like that so you

get that medication out of there that's

just going to sit there for the next

treatment it's not going to realize the

next year in sucking nebulized that's

absolutely normal that happens with this

type of mini we're going to move to the

next nebulizer and this one that's going

to give a higher dosage in a shorter

amount of time it's similar to a breath

actuated nebulizer in this case it's

it's at our nebulizer and I'll show you

what about it but this one we use a lot

in the ER or somebody we need to turn

around real quick this is our standard

nebulizer if you're getting treatments

on the floor if you're taking my home

you're gonna get these these are cheap

manufactured mass manufacturers so they

can't be defective so it's just a little

thing to watch out for one other helpful

hint now this is just a little Jimmy ISM

that I do with my nib so when I take a

nib out of the package the first time

right for our patient it's a draw I call

it a dry nib so it's almost always gonna

run faster the first time then the

second third fourth or fifth because

it's dry well I will commonly do with

the dad when I take it out of the

package is I will put saline inside of

it swish it around and then pour it out

what that does it kind of just starts

the nebulizer off so it's going to last

the same amount of time each time your

patients may complain I've had one

complaint before where they say

the nebulizer didn't take the other one

or the other was last night didn't take

us long why just changed in that me

eliezer house so it's very common I'll

do that I'll take it from a dry nap I'll

make it a wet nap but sailing in dumper

and out and then put the medication in

but I just think it's a patient

satisfier and it's something to give

that consistency in the treatment time

because when you give one of these it's

going to be really fast compared to what

they're doing at home and they'll tell

you over and over and over and over

again that this is way faster than what

they're doing at home because we're

using the compressed air I started

compressed oxygen on the wall 50 psi

leaves per minute and they're use a

little air compressor we're just always

going to run faster but you don't wanna

run a lot faster by giving that dry now

on the first and EV so it's just a

little helpful hint to think about but

let's get to the tower now so this

nebulizer looks a little different

you still have your nebulizer piece the

same a little thing they're just built a

little different here as you can see

that it has a little one-way valve on

the top and then the mouthpiece is here

so the mouthpiece but go on here we're

gonna run off the same liter flow as

before so we're running a liters and I'm

gonna show you a little bit about it it

delivers you can hear it running now is

no medication in it so let's piss off

this was a new name I'm gonna do just

like I said and the Saline then shake it

out pour it out and put the medication

in but this piece comes off the top

we're gonna add some normal saline

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same those at least three MLS usually up

to six we can go a little higher than

that we don't really like to if you're

going to look at this you're gonna see

some one-way valves right here you're

going to see one right there so that's

gonna help to direct medication and

really hold large doses in here so they

get large bills each time let's turn

this on

there's the nebulizer running and what

it's gonna actually do it's gonna fill

this little Tower with

nebulize medications that's ready to

deliver

and also what it does it really helps to

keep up with their inventory flow so

when they take this in they get a large

dose of it I like the way to hold it to

is a little easier than the teeth have

it kind of goes really nice in your hand

they can kind of do it like that they

want but I still always recommend just

keeping their mouth

they blow back through it

you can see the one-way valve and it

forces that air out that direction so

but it will nebulize quickly when it

gives some large doses so this is a

patient that is an asthmatic that needs

not just your two point five milligrams

we're going to be adding a lot more to

the treatment maybe five milligrams

seven and a half of ten milligrams so

large dosages it helps us deposit really

well because they get a lot more and

what they get with the team is so I just

just wanted to show that a little bit

and that's how that works you can do a

little messing around here put this

piece on here

goes in here and then what do you know

that Google on your masterwork of until

I feel that masks my big fat butt okay

so I want to do it what the mask I think

it's a waste but whatever it does have

that adapter in case you want to do that

you try to get him to do the mouthpiece

like I say that makes them take an

active role and doing their nebulizer

treatment so

hey guys I think that's all I have

please like subscribe comment to the RT

clinic and put any questions if you have

them thanks for watching I'll see you

also wanna thank the Indiana State

University PA program for the sweet

shirt that I'm able to wear in today's

video thanks guys

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