Nebulization Therapy

Nebulization:
Is the process of medication administration via inhalation. It utilizes a nebulizer
which transports medications to the lungs by means of mist inhalation.
Purposes:
The goal of nebulization therapy can be briefly summarized as “SHAPE”:
• S (Relief airway Spasm): to relieve bronchospasm, coughing and

wheezing:
• H (Humidify): to humidify airway.

• An (Anti-inflammation): to achieve an anti-inflammatory effect.

• P (Prevent): to prevent respiratory complications such as airway

inflammation, obstruction, atelectasis, infection, and asphyxia.

• E (Expectorant): promote expectoration.

Indication:
Nebulization therapy is used to deliver medications along the respiratory tract and
is indicated to various respiratory problems and diseases such as:
▪ Bronchospasms
▪ Chest tightness
▪ Excessive and thick mucus secretions
▪ Respiratory congestions
▪ Pneumonia
▪ Atelectasis
▪ Asthma
Contraindications:
In some cases, nebulization is restricted or avoided due to possible untoward
results or rather decreased effectiveness such as:
▪ Patients with unstable and increased blood pressure
▪ Individuals with cardiac irritability (may result to dysrhythmias)
▪ Persons with increased pulses
▪ Unconscious patients (inhalation may be done via mask but the
therapeutic effect may be significantly low)

Equipment:
• Nebulizer and nebulizer connecting tubes.
• Compressor oxygen tank
• Mouthpiece/mask
• T-piece connector.
• Respiratory medication to be administered.
• Normal saline solution
• Hand disinfectant.
• Stethoscope.
• Disposable gloves (PPE as indicated).

Complications:

Possible effects and reactions after nebulization therapy are as follows:

• Palpitations
• Tremors
• Tachycardia
• Headache
• Nausea
• Bronchospasms (too much)

Nebulizer Parts
 Nebulization Procedure

# Steps Rational
Pre-procedure
1. Verify physician prescription. To avoid any mistakes
2. Wash Hands. To maintain infection control
3. Prepare needed equipment. To save time and effort
4. Introduce yourself to the patient. To build trust.
5. Verify the patient by 2 Nurses. To ensure that, right patient receives
intervention.
6. Explain procedure to the patient. To decrease patient's anxiety and
increase patient’s cooperation
7. Keep patient privacy. Patient right( to decrease patient
embarrassment )
8. Position the patient appropriately, allowing To facilitate the administration of the
optimal ventilation. medication.
Sit up straight on a comfortable chair.
Using a mouthpiece is preferred. When
using a mouthpiece, place the mouthpiece
between the teeth and ask the patient to seal
his/her lips around it.
If the patient is using a mask, position it
comfortably and securely on the face.

9. Disinfect your hand. To maintain infection control

10. Wear disposable gloves. To maintain infection control
During procedure
11. Assess and record breath sounds, To provide a baseline for evaluation
respiratory status, pulse rate and other the effectiveness of nebulization
significant respiratory functions. Ask the therapy.
patient about allergies.

12. Check the doctor’s orders for the To avoid any mistakes.
medication, prepare thereafter.
 Place the premeasured medication in the To get enough volume to make a fine
bottom section of the cup or use a dropper mist that can be inhaled.
to place medication. Add prescribed diluent
(usually Saline) if ordered.
13.

Screw the top portion of the nebulizer cup Air or oxygen must be forced through
back in place and attach the cup to the the nebulizer to form a fine mist.
nebulizer. Attach one end of the tubing to To secure the passage of aerosol mist
the stem on the bottom of the nebulizer cuff to the lungs.
and the other end to the air compressor or
oxygen source.
14.

For patient on mechanical Ventilator: To deliver medicine by using high-

frequency vibrations to convert the
1. Unhook the ventilator tubing and insert liquid into an aerosol and do not
the T-piece into the ventilator tubing on increase patient tidal volume during
the inhalation side.
2. Insert the nebulizer cup into the T-piece
that is now in line with the ventilator
15.
circuit.
3. Connect one end of the tubing to the
bottom of the nebulizer and the other
end to the aerosol/nebulizer machine.
4. Once nebulizer is done, suction the trach
to remove secretions. inhalation.
16. Turn on the air compressor or oxygen. To prevent any leakage while receiving
Check that a fine medication mist is the medication.
produced by opening the valve. Have the
patient place the mouthpiece (or Mask) into
the mouth and grasp securely with teeth and
lips.

17. Offer the nebulizer to the patient, help until To assess patient ability to receive the
she/he can perform proper inhalation (if medication and to start medication on
unable to hold the nebulizer, replace the time.
mouthpiece with mask)

18. Instruct the patient to inhale slowly and To let the medication come in contact
deeply through the mouth. A nose clip may with respiratory tissues and can be
be necessary if the patient is also breathing absorbed. The longer the breath is held,
through the nose. Hold each breath for a the more medication can be absorbed.
slight pause, before exhaling.

19. Continue the inhalation technique until the For optimal delivery of medication to
all medication in the nebulizer cup has been the
aerosolized (about 5 to 15 minutes). patient.

20. Observe for any possible side effects or To prevent any complications and
inhalation reactions. reporting it in timely manner.
21. When the medication is completely To avoid oral fungal infections due to
aerosolized, the cup will be empty. Have inhaled steroids.
the patient remove the nebulizer from the Rinsing removes medication residual
mouth and gargle and rinse with tap water, from the mouth.
as indicated.
 22. Reassess patient status from breath sounds, To ensure the effectiveness of the
respiratory status, pulse rate and other medication given and to write down
significant respiratory functions needed. any changes or differences in the
Compare and record significant changes patient’s condition. Lung sound,
and improvements. Refer if necessary. Oxygen saturation level may improve
after nebulizer use. Respiration may
decrease as well.
Post procedure
23. Dispose of equipment appropriately. To reduce risk of transmission of
microorganisms.
24. Clean the nebulizer and take it apart and To kill bacteria and remove build-up.
wash all of the parts in warm, soapy water.
Store nebulizer and equipment according to
facility’s policy.
25. Remove used gloves and discard in the To maintain infection control.
proper bag (Red).
26. Wash hands. To maintain infection control.
27. Record patient's assessment before and To maintain patient’s safety and keep-
after intervention, medication dosage and documented source helps in following
name, date, time, oxygen saturation. patient’s status.
28. Report any abnormalities to the physician To take necessary actions.
such as allergic reactions or pain.

Procedure Video Links:

https://www.youtube.com/watch?v=V44OI-FjBCk&t=4s
https://youtube.com/watch?v=Z5Lx--xlj28
https://youtube.com/watch?v=afSqRIdwwdM

References:
− Lynn, P., 2019. Taylor’s clinical nursing skills: A nursing process approach,
Philadelphia, PA: Wolters Kluwer Health.
− Perry, A.G., Potter, P.A., Ostendorf, W.R. and Laplante, N., 2021. Clinical
nursing skills and techniques-E-Book. Elsevier Health Sciences.
− https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6803223/#:~:text=Nebulization
%20therapy%20can%20be%20used,airway%20management%20in%20other%
20diseases.
− https://www.urmc.rochester.edu/childrens-hospital/tracheostomy-ventilator-
program/ventilator/nebulizer-
treatments.aspx#:~:text=Place%20the%20medicine%20in%20the,line%20with
%20the%20ventilator%20circuit.