Pediatrics –Medication: Administration of Nebulizer TreatmentSECTION: 20.12

Strength of Evidence Level: 3__RN__LPN/LVN__HHA

PURPOSE:

To administer a nebulizer treatment to increase the efficacy of medication on the child’s airway and lungs.

CONSIDERATIONS:

  1. It is appropriate to use a face mask for an infant or small child thatis fatigued and/or not able to participate.
  2. Usually a child under 18 months of ageexperiences a better effect from the inhaled treatment when a mask is used.
  3. An adaptor or tracheostomy mask is appropriate for a child with a tracheostomy.

EQUIPMENT:

Medication

Diluent, such as normal saline, if needed

Nebulizer medication chamber and tubing assembly

Smallvolume nebulizer machine or oxygen, as directed by physician

Pediatric-sized aerosol mask, face tent or tracheostomy mask

PROCEDURE:

  1. Adhere to Standard Precautions.
  2. Gather all equipment.
  3. Identify the patient and explain procedure to caregiver and patient, if age appropriate.
  4. Auscultate lung sounds.
  5. Assemble the nebulizer medication chamber and tubing according to manufacturer instructions.
  6. Attach aerosol tubing to nebulizer outlet port.
  7. Following the prescribed amount of medication, fill nebulizer medication chamber with dose.
  8. Attach patient’s appliance (mouthpiece or mask).
  9. Verify that all connections are secure.
  10. Instruct the patient to hold the mouthpiece between his/her lips with gentle pressure.
  11. Power on the nebulizer. A fine mist should appear in the mouthpiece/mask. This is a sign that the machine is working properly.
  12. Instruct the patient to sit in an upright position. It is helpful if the caregiver can hold the child if he/she is unable to sit upright or will not sit still. Most nebulizers work best when the chamber is kept upright. This ensures that the humidified air does not bypass the medication chamber.
  13. Gently tap the nebulizer cup frequently to allow for even distribution of medication.
  14. Instruct the patient to breath normally. Deep breathing is not necessary.
  15. Once the liquid medication is gone and mist no longer forms, power off the machine.
  16. Instruct the patient to gargle with warm water after the treatment.
  17. Auscultate lung sounds.

AFTER CARE:

  1. Document in the patient’s record:
  2. Patient’s response to treatment, e.g., breathing, wheezing, color, activity.
  3. Instructions given to caregiver.
  4. Vital signs.
  5. Lung sounds as noted before and after treatment.
  6. Clean the medication chamber, mouthpiece and T-piece with soap and water after each use. Allow equipment to air dry on a clean surface. DO NOT wash the tubing.
  7. Replace filter and tubing per manufacturer instructions.