Saline (0.9%) Nebuliser Guideline

Transcription

1 Saline (0.9%) Nebuliser Guideline Full Title of Guideline: Author (include and role): Division & Speciality: Version: 3 Ratified by: Scope (Target audience, state if Trust wide): Review date (when this version goes out of date): Explicit definition of patient group to which it applies (e.g. inclusion and exclusion criteria, diagnosis): Changes from previous version (not applicable if this is a new guideline, enter below if extensive): Saline (0.9%) Nebuliser Guideline For Practice Eleanor Douglas, Lecturer/Practitioner Physiotherapist Eleanor.douglas@nuh.nhs.uk Clinical Support, Physiotherapy Senior Physiotherapists at NUH Trust wide physiotherapists September, 2021 Patients who are having difficulty clearing pulmonary secretions due to dehydration of the upper airway e.g. post operative patients and those were their upper airway has been bypassed e.g. tracheostomy patients. It excludes patients in acute bronchospasm and those with hyper-responsive airways. Review of research, minor changes to wording, grammar and spelling errors corrected. Expert committee reports or opinions and / or clinical Summary of evidence base this experiences of respected authorities. Recommended best guideline has been created from: practise based on the clinical experience of the guideline developer This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date or outside of the Trust. Page 1 of 5

2 Saline (0.9%) Nebuliser Guideline For Practice 2018 Version: This replaces the Saline Nebuliser Guidelines for Practice, May 2015 Review Date: September 2021 Contact: Eleanor Douglas, Lecturer/Practitioner Physiotherapist. Ext: Disclaimer This guideline has been registered with the Nottingham University Hospitals Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in any doubt regarding this procedure, contact a senior colleague. Caution is advised when using guidelines after the review date. Please contact the named above with any comments / feedback. Introduction / Indications For Use This procedure describes the aerosol administration of isotonic saline in aerosol form and maybe indicated in the following circumstances: for sputum specimens or mobilisation of secretions, in patients who s upper airway is bypassed (Endotracheal or Tracheostomy tube) and for hydration of the upper airway in patients who are nil by mouth. Administration may or may not be accompanied by oxygen administration. The use of 0.9% normal saline is primarily indicated for upper airway administration. The use of 7% hypertonic saline is primarily indicated for inducing sputum specimens the Induced Sputum Guideline (2018) should be referred to for this procedure. Contraindications/Precautions Bronchospasm History of airway hyper responsiveness Complications Wheezing or bronchospasm Infection Overhydration Patient discomfort Oedema of the airway wall Oedema associated with decreased compliance and gas exchange and with increased airway resistance Limitations The efficacy of intermittent use of saline nebulisers as a means of reducing mucus has not been established. Saline nebulisers are not a substitute for systemic hydration. The physical properties of mucus are only minimally affected by the addition of water aerosol. Saline nebulisers for humidification purposes are not as efficient or effective as heated water humidifiers when the upper airway has been bypassed. Page 2 of 5

3 Procedure Action Prescription of 5mls of 0.9% saline on the drug chart by a qualified prescriber. To be delivered by nebuliser route. Can be prescribed either regularly or PRN on the patients drug chart. Check the saline, amount and expiry date with another qualified member of staff e.g. nurse or physiotherapist Assist the patient into a comfortable position, Preferably sitting upright and advise to take normal steady breaths (tidal volume) Explain to the patient the effects of the nebuliser Wash hands and place the saline into the nebuliser chamber Connect one end of the nebuliser tubing to the compressor or oxygen flow meter (the oxygen flow rate should be set at 6-8 l/min) and the other end to the nebuliser chamber. Select mouthpiece or face mask and connect to the nebuliser chamber Observe the patient during the procedure for any change in condition Occasionally tap the nebuliser chamber during nebulisation. The patient could be encouraged to do this if able Keep nebuliser chamber upright Nebulisation should be complete after 5-10 minutes. There will always be a small amount of fluid left in the chamber. Switch off the compressor or flow meter After each use discard the remaining saline and clean the chamber as follows: Clean and rinse the nebuliser chamber with sterile water. Tap water should not be used Ensure the chamber is thoroughly dried using a clean paper towel Chambers should be used for a 24hour cycle and then be disposed of Masks should be cleaned regularly All equipment should be replaced when soiled The nebuliser unit should be covered and stored The compressor should be wiped clean after use Rationale Drug is given as prescribed Drug is given as prescribed and avoids administration errors To minimise dyspnoea and to allow maximum lung expansion in order to ensure medication reaches the bronchioles To educate the patient To reduce the risks of cross infection To enable the drug to be nebulised correctly. Note: In patients with a known hypoxic respiratory drive the nebuliser should be driven by an air compressor and the patients oxygen can remain in situ via nasal cannula (1-4 litres of oxygen) To monitor the patient in case of any adverse effect This shakes down the large droplets into the chamber and ensures maximum delivery of the saline This allows maximum amount of saline to be delivered effectively Nebulisers cannot be run to dryness To reduce the risk of colonization of the equipment Organisms may multiply in any fluid left in the equipment and may then be inhaled by the patientto reduce the risk of bacterial contamination being aerosolized To reduce the risk of the chamber becoming blocked Crystallisation of the nebuliser pot may occur if saline solution is allowed to dry or evaporate and this may effect the effectiveness of the nebuliser To keep clean and dust free Page 3 of 5

4 Care of equipment Compressor Wipe with a damp cloth when the unit is unplugged and store it in an appropriate place, the compressor should not be stored on the floor or near water hazards. Compressors must be regularly serviced every 6 months by MESU. Nebuliser pots/masks Eliminating sticky fluids from the nebuliser and condensation from the tube allow the nebuliser system to produce the quality and output as required. Adequate washing of the pot and mask after each treatment is therefore an important part of the cleaning procedure. Equipment should be replaced when soiled. References AARC Clinical Practice Guideline. Bland Aerosol Administration 2003 Revision and Update. Respiratory Care 48: Adult Nebuliser Guidelines. Nursing Practice Guidelines. Nottingham City Hospital/Queens Medical Centre/ Rushcliffe PCT Lannefors L,Heslop C, Tierlink, C (2000) Nebuliser Systems. European Respiratory Society Nebuliser Guidelines: Clinical Aspects 76: 572 Page 4 of 5

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