Directions for hospitals.pdf

CONTINUOUS NEBULIZER TREATMENT
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PROCEDURE FOR MASK DELIVERY
Check physician’s order. The continuous bronchodilator nebulization therapy (CBNT) order should include treatment duration and total number of mg and/or cc to be delivered per hour. The physician’s order may also include a desired FIO2. The CBNT must be reordered after the completion of the initial therapy.
Identify patient. Explain the purpose and procedure to the patient The patient must be in a unit that will provide continuous cardiac and SPO2 monitoring such as ICU, SICU, ER or the Pediatric Unit. The availability of both O2 and AIR outlets may be necessary when precise oxygen concentrations are warranted.
Assess the patients HR, RR, WOB, SPO2, Breath Sounds, Color, Peak Flow, Current O2 Device and ABG values, if available.
Remove the medication and saline from the storage area. Be sure to charge per department policy for the correct amount of medication.
Prepare the medication and normal saline as noted under Section IV of this policy. Pour medication and normal saline into reservoir.
Attach the oxygen supply tubing to the 50 psi wall outlet and/or oxygen tank and regulator unit. Turn the flowmeter to the desired flow rate per manufactured specifications.
Special Note: The EZflow (light blue reservoir) operates at 3 liters per minute. The
EZflow MAX (dark blue reservoir) operates at 6 and 10 liters per minute flow. This is
important in order to determine the nebulizer output (mist produced) over a one
hour period of time.
Place mask snugly, not tightly, onto the patient’s face. Monitor the patient closely for several minutes of CBNT. Certain variables may affect nebulizer function, such as wall outlet pressure and potential flowmeter inaccuracies. Check the nebulizer output and titrate accordingly. Assess the patient every 30 minutes initially, then every hour for the duration of the therapy. The assessment should include HR, RR, WOB, SPO2, breath sounds and peak flow.
CONTINUOUS NEBULIZER TREATMENT
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The nebulizer output for the EZflow (low flow, light blue reservoir) is 6 ml per hour @ 3 liters per minute flow. The nebulizer output for the EZflow MAX (high flow, dark blue reservoir) is 12 ml @ 6 liters per minute flow and 16 ml @ 10 liter per minute flow. The medication reservoir capacity for both high and low flow systems is 24 ml. Therefore, the low flow system can nebulize up to 4 hours continuously, the high flow up to 1-1/2 hours at 10 liters per minute.
Chart the CBNT in accordance with the Respiratory Care Department policy.
The equipment used for the CBNT is single patient use and should be discarded after use. Change the EZflow nebulizer after 48 hours of use.
When a precise oxygen concentration is required, utilize a properly calibrated blender.
ADVERSE REACTIONS
Stop the CBNT if adverse reactions occur. Return patient to previous O2 device. Remain with the patient until adverse symptoms subside. Notify the physician immediately. Adverse reactions may be any of the following: MEDICATION CALCULATION
The preparation and calculation in this protocol applies to Albuterol. The use of anyother bronchodilator in place of or with Albuterol must be reviewed by the physician.
Recommended Albuterol Dosage:
Calculations:
Albuterol - .5% Solution (5mg = 1ml, 10mg = 2ml, 15mg = 3ml, 20mg = 4ml) CONTINUOUS NEBULIZER TREATMENT
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Mg/Hr of medication ordered divided by 5 equals the ml of medication used Note the nebulizer’s output (amount of mist produced per hour) per manufacturer specifications. EZflow - Low Flow (light blue reservoir) is 6 ml operating at 3 liters per minute flow. The EZflow MAX - High Flow (dark blue reservoir) output is 12 ml operating at 6 liters per minute flow and 16 ml at 10 liters per minute flow.
Follow this equation for a one (1) hour treatment:
(Output of nebulizer) - (ml of medication ordered) = ml of Normal Saline to add
If multiple hours of therapy is ordered by the physician, multiply both the medication ordered in ml and the saline diluent in ml times the number of hours desired.
EZflow - Low Flow (Light Blue Reservoir)
Output 6cc @ 3 lpm flow
DOSING REFERENCE
5 mg (1 cc/Hr)
Output @ 3 lpm
Albuterol in cc’s
Saline Mixture
10 mg (2 cc/Hr)
Output @ 3 lpm
Albuterol in cc’s
Saline Mixture
CONTINUOUS NEBULIZATION TREATMENT
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15 mg (3 cc/Hr)
Output @ 3 lpm
Albuterol in cc’s
Saline Mixture
20 mg (4 cc/Hr)
Output @ 3 lpm
Albuterol in cc’s
Saline Mixture
EZflow MAX - High Flow (Dark Blue Reservoir)
6 Liters per Minute flow
DOSING REFERENCE
5 mg (1 cc/Hr)
Output @ 6 lpm
Albuterol in cc’s
Saline Mixture
CONTINUOUS NEBULIZATION TREATMENT
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10 mg (2 cc/Hr)
Output @ 6 lpm
Albuterol in cc’s
Saline Mixture
15 mg (3 cc/Hr)
Output @ 6 lpm
Albuterol in cc’s
Saline Mixture
20 mg (4cc/Hr)
Output @ 6 lpm
Albuterol in cc’s
Saline Mixture
EZflow MAX - High Flow (Dark Blue Reservoir)
10 Liters per Minute flow
DOSING REFERENCE
5 mg (1 cc/hr)
Output @ 10 lpm
Albuterol in cc’s
Saline Mixture
10 mg (2 cc/hr)
Output @ 10 lpm
Albuterol in cc’s
Saline Mixture
CONTINUOUS NEBULIZATION TREATMENT
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15 mg (3 cc/hr)
Output @ 10 lpm
Albuterol in cc’s
Saline Mixture
20 mg (4 cc/hr)
Output @ 10 lpm
Albuterol in cc’s
Saline Mixture
TREATMENT COMPLICATIONS
Failure may include, but is not limited to the following: Failure to significantly respond in 8 hours.
Decreasing aeration over time or increased wheezing without asimultaneous increase in aeration.
Decreasing pulse oximeter readings or an increasing need for higherFiO2’s to maintain the same saturation.
Decreased level of consciousness or decreased ability to awaken the patient.
Anything that leads you to believe, through your assessment,that the patient is getting worse.
Be aware that there can be a decrease in electrolyte levels, specifically Potassium (K+). Patients receiving beta agonists may benefit fromhaving their electrolyte levels periodically evaluated by a physician.
When treatment failure is suspected, re-evaluate the patient and contactthe physician immediately.

Source: http://mercurymed.com/pdf/ezflow_hosp_dir.pdf