Nebuliser Training - Carer Skills Passport



10163739-840078Carer Skills PassportStandardised Training for parents and carers13179353795314Nebuliser TrainingJenny Bayliss Specialist Nurse8376708-483827Nebuliser – what is it?A nebuliser is a machine that turns a liquid into a vapour or mist that can be inhaled directly into the lungs. Through the nose and mouth or tracheostomy to help breathing and keeping the lungs healthy. The machine come in di?erent styles but do the same thing.AimsThe Training session in using a nebuliser and this information book aims to help parents and carersTo know what a nebuliser isTo understand why, when and how a nebuliser is givenTo know how to set up and use a nebuliser machineTo know how to look after and clean a nebuliser machineTo know when to get helpWhy do children with complex needs have respiratory problems??????Children with complex physical needs often have respiratory problems due to being Non-mobilePoor cough and airway clearance Problems with swallowing and aspiration Muscle weakness and scoliosis591954092570610052051260774All of these mean secretions can settle onto the lungs causing infection and if left untreated can make the child or young person very poorly.How do I know there's a respiratory problem????????16530037578411You will learn to recognise when the child or young person you care for is struggling. There will be indications such asNoisy breathing (including wheeze)Working hard to breath Poor colourNot maintaining saturations Coughing a lotThick, sticky secretions that are di?cult to suction Secretions that are no longer white or clearHow can we help?Prevention is key in supporting a healthy Respiratory SystemHave you heard of PRN?A respiratory assessment will be carried out by a physiotherapist and a plan is put in place, such as??Chest physiotherapy to help with secretions?Postural changes to see which position changes the child or young person (CYP) will bene?t from and are able to use (e.g tummy time, standing frames, various position changes etc)Cough assist for those who cannot cough themselves.This helps them to cough up??secretions preventing chest infectionsSuction can help clear secretions where a CYP cannot do it themselves Nebulisers help loosen secretions so that they can be coughed up and suctionedPRN is a shortened word for the Latin word "pro re nata", which means "when needed or when required".A saline nebuliser may be administered as prescribed on a regular basis at certain times to keep secretions loose and easy to cough up (where the CYP has a cough re?ex). This is a preventative measure. Saline nebulisers are also usually prescribed "when required" (or PRN) and can be given as extra when secretions become thick, di?cult to cough up or suction.In a child with a tracheostomy or nasopharyngeal airway sticky secretions can place them at risk of a blocked tube.Saline nebulisers are sometimes given before chest physiotherapy to help loosen secretions so that these can be coughed up/ suctioned out if needed.There are di?erent makes of nebulisers and di?erent ways they can be used, such as, by a mouth piece, face mask, tracheostomy mask or via a ventilator circuit.Nebulisers and circuitsGiving a Nebuliser???A nebuliser is a medicine and should be prescribed like any other medicine The medicine needs to be nebulised using air or oxygenThe nebuliser machine generates the air pressure for you automatically.?Oxygen is used if the child or young person cannot maintain their saturation levels but this needs to be prescribed.?10387118-218845167534167863590.9% Normal Saline is the most common nebuliser used for loosening secretions?A steroid can be given for an in?amed, wheezy sounding or tight chest to open the airwaysExample of set up of antibiotic nebuliserSide E?ectsTracheostomy maskFilterNebuliser solutionAntibioticThis is a picture of a nebuliser set up to give the antibiotic colomycin by a tracheostomy mask. There is a ?lter attached to ?lter the particles of the antibiotic.As with all medicines, the child or young person should be monitored for side e?ects and consider stopping the nebuliser if symptoms indicate. The nebuliser is not expected to cause any side e?ects in normal use.Do not use the nebuliser solution unless the product is clear and the pack intact. Discard any surplus solution after use to prevent contamination, which could cause the child to become unwell.Patients using nebulisers at home should be aware that if the usual relief reduces or has little e?ect, they should consult their doctor. Always report adverse reactions to the doctor and seek medical advice if you are practising outside your limitationsAlways observe the child or young person during the nebuliser to make sure they are settled and are coping. Carry out a respiratory assessment before, during and after.You may need to stop the nebuliser to suction if they are coughing a lot and the secretions are very loose causing them to be unsettled and /or cyanosed.Be mindful that excessive suctioning can lead to more secretion production.If the child or young person is not settled and managing to tolerate the nebuliser in air, oxygen may be given if it is prescribed.Procedure for giving a nebuliser?Check the prescribed medication with the prescription sheet. Always check the medicine is the right one for the right child and that it is within the expiry date before it is given?The nebuliser comes with 3 parts – a chamber (or pot or acorn), a mouthpiece/ tracheostomy connector or mask and tubing?The chamber comes in 3 parts – the bottom of the chamber has a gas inlet. This is where the tubing is attached and the medicine goes?The mushroom shaped piece of plastic over the gas inlet (that comes o?), is needed to allow the nebuliser to work?The top of the blue chamber screws back onto the bottom, a mask or a mouthpiece ?ts here (The mask needs to be the right size for the child or young person. A tracheostomy mask is used for tracheostomies). If on a ventilator the nebuliser can be given through the ventilator circuitProcedure for giving a nebuliser continued?Encourage the child or young person (if appropriate) to take deep breaths whilst the nebuliser is on to help it work to its maximum. Keep the nebuliser chamber upright and you may need to alter its position every so often so that all the medication can be used?Make sure the choice of air or oxygen is right. If oxygen is used it must be prescribed. The ?ow meter should be set to 6-8L or depended on the manufacturers instructions. If using an electronic nebuliser this will create the air for you10509977-12485? The child or young person should be observed for side e?ects10509977-4686? Allow 10-15 minutes to administer the nebuliser.Once the nebuliser has ?nished you will be able to hear the di?erence in sound. The machine can then be switched o??Observe the e?ect of the nebuliser on the CYP and document. They may need suction or additional interventionWe are all learning all of the time and it's important to practice so that you learn more easily12732596-4627208PracticePractice looking at your child and listening to their chest when they are due to have their nebuliser routinely. Look at them and listen to them after their nebuliser. Has it made a di?erence?Practice looking at and listening to your child when the nurse or physio have said they are wheezing and need a nebuliserIt's a good idea to look at how your child is normally and how they are when they are unwell and see how a nebuliser helps them. Remember to carry out a holistic assessment.If ever you have questions or feel out of your depth ask a health care professional. Never practice outside your limitations. ................
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