Pediatrics –Medication: Use and Cleaning of SpacerSECTION: 20.22

Strength of Evidence Level: 3__RN__LPN/LVN__HHA

PURPOSE:

To increase through use of a spacer the amount of medicine that gets into the lungs when attached to a metereddose inhaler (MDI).

CONSIDERATIONS:

  1. Different types of spacers are used depending on the age of the child.Options may include Aerochamber with Mask, Inspirease and Aerochamber.
  2. It is important to ensure the child’s lips have a proper seal around the spacer.If using a mask, ensure proper seal to face.

EQUIPMENT:

Metered dose inhaler

Spacer

Warm water (used for cleaning portion of this procedure)

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. Remove cap from inhaler.
  6. Shake canister to mix the medicine before use.Attach inhaler to the spacer.
  7. The patient should stand up straight and hold his/her head tilted back slightly.
  8. Instruct the patient to exhaleslowly and completely before using inhaler.
  9. Depress inhaler.This will send one puff of the medicine in the holding chamber of the spacer.
  10. Place the mouthpiece of the spacer immediately to the patient’s mouth.Be sure to have the patient form a tight seal with his/her lips around the mouthpiece.Instruct him/her to inhale slowly.
  11. Instruct the patient to hold his/her breath for 10 seconds.This will allow the medicine to reach deep into the lungs.It may be helpful to hold the patient’s nose closed to be sure that the medication goes into the his/her throat.
  12. If ordered dose is greater than one puff, repeat the above steps.Shake inhaler well before each puff.
  13. Upon completion, remove inhaler from spacer and replace protective cap.
  14. Instruct the patient to rinse his/her mouth with water and spit out.It is important not to swallow.Rinsing the mouth will help prevent a dry throat and relieve any unpleasant aftertaste.
  15. Auscultate lung sounds.

AFTER CARE:

  1. Instruct the patient to rinse his/her inhaler mouthpiece, cap and spacer once a day with warm water.This will prevent the equipment from clogging and not working well.After rinsing the equipment, allow to air dry.DO NOT towel dry as this may leave lint in the spacer.
  2. Document in the patient’s record:
  3. Lung sounds before and after treatment.
  4. Vital signs.
  5. Instructions given to caregiver.
  6. Status of oral mucosa.