Adult Nebulisation Therapy - | Health



Canberra Hospital and Health ServicesClinical ProcedureAdult Nebulisation TherapyContents TOC \h \z \t "Heading 1,1" Contents PAGEREF _Toc432075681 \h 1Purpose PAGEREF _Toc432075682 \h 2Alerts PAGEREF _Toc432075683 \h 2Scope PAGEREF _Toc432075684 \h 2Section 1 – Nebulisation Therapy Management PAGEREF _Toc432075685 \h 3Implementation PAGEREF _Toc432075686 \h 4Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc432075687 \h 4References PAGEREF _Toc432075688 \h 5Search Terms PAGEREF _Toc432075689 \h 5PurposeTo provide clinical staff with clear guidelines on the safe and effective management of an adult patient, receiving nebulisation therapy at Canberra Hospital Health Services (CHHS). CHHS Medication Handling policy (section 5.9.9) outlines when nebulisation therapy can be administered within the adult ward settings. Where possible an inhaler device with a spacer is the preferred method of administration, as this provides better medication uptake and should be used instead of nebuliser therapy. Nebulisation Therapy is prescribed to: Administer medicationsAssist in the removal of accumulated bronchial secretionsLiquefy bronchial secretionsRelieve bronchospasm & dyspnoeaAlertsNebulisation therapy should be undertaken in a negative pressure room to prevent the spread of airborne infection to hospital staff and patients. If a negative pressure room is unavailable, a single room should be used and the door kept closed. Place an “Airborne” precaution card in the Nobo? frame outside the room.Patients with Chronic Obstructive Pulmonary Disease (COPD) should not receive nebulisation therapy using oxygen.Nebulisation therapy is prescribed for a limited number of patients (e.g. upper airway obstruction and severe bronchospasm in the absence of pneumonia).Where indicated, simultaneous oxygen maybe administered via nasal cannula.Specialist Medical Officer (SMO)/Visiting Medical Officer (VMO) input is required for any patient who has an illness of sufficient severity to warrant nebuliser therapy. The use of nebulisation therapy is a SMO/ VMO level decision.ScopeThis clinical procedure applies to all ACT Health clinical staff who administer/manage nebuliser therapy for adult patients. They include:Specialist MO/ VMONurses and Midwives who are working within their scope of practice (Refer to Nursing and Midwifery Continuing Competence Policy)Student Nurses under direct supervision.The clinical procedure pertains to adult patients requiring nebuliser therapy at CHHS.Section 1 – Nebuliser Therapy Management Equipment Alcohol based hand rub (ABHR)Medication as prescribedAmpoule sodium chloride 0.9% or sterile waterNebulisation mask, mouthpiece and tubingOxygen tubing (optional)Nipple adaptor for air or oxygen outlet or air compressorPersonal protective equipment (PPE) including safety goggles or shield, mask and clean gloves High Filtration Mask (P2/N95)“Airborne” precaution warning card Procedure Patient identificationSingle room is required for all nebulisation therapy and a negative pressure room is recommendedCheck medication order and collect required medications and equipmentPlace an “Airborne” precaution card in the Nobo? frame outside the roomAttend hand hygiene before touching the patient by either hand washing or using ABHRExplain the procedure to the patientObtain consentDon high filtration mask for certain drugs onlyDon PPEAssist the patient to a sitting or semi-recumbent positionAttend pre-medication peak flow measurement if indicated Document in the patients clinical recordsTwist nebule to openPlace the open end of the nebule well into the nebuliser bowl and squeeze it slowly until all the liquid has been emptied into the nebuliser bowlAdd sodium chloride 0.9% or sterile water to make up a minimal volume of 4mLReconnect the nebuliserAttach the tubing to the nebuliser, then to the air or oxygen outlet or air compressorIf using an air pump, switch the power onFor oxygen or air, adjust the flow rate (no less than 6L/minute and no more than 8L) to achieve a fine mistEnsure the mask is properly fitted to the patient’s faceInstruct the patient to breathe deeply and slowlyIf using a nebuliser with a mouthpiece, instruct the patient to close the lips firmly around the mouthpiece and to inhale through their mouth and exhale through the noseObserve for any of the following side effects, report to the MO/VMO and the MO/VMO will then decide if the nebulisation therapy should continue or be ceased. Document any of the below side effects:Tachycardia/palpitationsCyanosisFlushingHeadachesFine muscle tremors (especially hands)Vertigo Wash the nebuliser with tap water and leave to air dry following each usageAttend post procedure peak flow measurement ten minutes after inhalation if indicatedAttend hand hygiene after touching the patient by using either hand washing or ABHR Remove PPEAttend hand hygiene after by using either hand washing or ABHR Record nebuliser administration on the patient’s medication chart Document in the patient’s clinical record, the patient’s response to the procedure, including pain/discomfort during and immediately after the nebuliser treatment.The Nebuliser set is classified as single patient use.? They should be checked by staff and if the patient is having the nebulisation therapy long term then infection control would ?recommend that they change the nebuliser and line once a week.Back to Table of Contents Implementation The use of nebuliser therapy is not new in CHHS but has restricted usage. Education and training to hospital staff will occur at ward level by the Clinical Development Nurse (CDN) and/or senior Nurses and Midwives. Back to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationPoliciesCHHC Medication Handling Policy Nursing and Midwifery Continuing Competence PolicyACT Health Waste Management PolicyProceduresCanberra Hospital and Health Services- Healthcare Associated Infections 19/03/2015Nursing and Midwifery Continuing Competence SOP to Table of ContentsReferencesAsthma Management Handbook, 2014 Centre for Disease Control and Prevention, 2004 Esmond G, Update. Nebulisation Therapy, Professional Nurse, 1998; 14(1): 39World Health Organization (WHO) Guidelines on Hand Hygiene in Healthcare, 2009. moments of Hand Washing- Hand Hygiene Australia, 2015 Back to Table of ContentsSearch Terms Nebuliser, Therapy, Peak flowBack to Table of ContentsDisclaimer: This document has been developed by ACT Health, <Name of Division/ Branch/Unit> specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Date AmendedSection AmendedApproved ByEg: 17 August 2014Section 1ED/CHHSPC Chair ................
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