NEBULIZATION
- Dr KUNIKA JAISWAL
DEFINITION
Nebulization is means of administering drugs by
inhalation.
Liquid Nebulisation is a common method of medical
aerosol generation.
A nebuliser is a device that converts liquid into aerosol
droplets (fine mist) suitable for inhalation.
Nebulisers use oxygen, compressed air or ultrasonic power
to break up medication solutions and deliver a therapeutic
dose of Aerosol particles directly to the lungs.
Most aerosol medication have bronchodilating effects
and are administered by respiratory therapy personnel.
PURPOSE
1. To relieve respiratory insufficiency due to bronchospasm.
2. To correct the underlying respiratory disorders responsible for
bronchospasm.
3. To liquefy and remove retained thick secretion form the lower
respiratory tract.
4. To reduce inflammatory and allergic responses the upper
respiratory tract.
5. To correct humidify deficit resulting from inspired air by
passing the airway during the use of mechanical ventilation in
critically and post surgical patients
6) When a child or young person has
an acute asthma attack.
7) When a child or young person is
in respiratory distress.
8) When a child or young person
has stridor.
9) If child or young person is
unable to use an inhaler.
INDICATIONS
Delivery of bronchodilator drugs : On acute attack of
asthma Nebulization is the most common means of
delivery.
Administration of antibiotics and anti antifungal
agents: In some cases of resistant chest infections for
eg.cystic fibrosis antibiotics may be prescribed to be
inhaled directly into the lung.
To aid expectoration : Inhalation of hypertonic saline
has been found to increase clearance of bronchial
secretions.
Local analgesia: To relieve dyspnea in patients such as
those suffering from alveolar carcinoma
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)
PARTICLE SIZE
Mass median aerodynamic diameter
≤ 1μm : Reach up to the alveoli,
0.5-5μm: Beyond the 10th generation of bronchi
(respirable particles),
≥ 5 μm : oropharynx
NEBULIZERS
Solution or suspensions can be nebulized by ultrasonics
or an air jet and administered via a mouthpiece,
ventilation mask or tracheostomy.
Types of nebulizers :<J UV>
Jet nebulizer
Ultrasonic wave nebulizer
Vibrating mesh Nebulizers
TYPES OF NEBULIZER
1. Inhaler or meterd- dose nebulizer
2. Jet nebulizer
3. Ultrasonic nebulizer
NEBULIZERS
Solution or suspensions can be nebulized by ultrasonics
or an air jet and administered via a mouthpiece,
ventilation mask or tracheostomy.
Types of nebulizers :
Jet nebulizer
Ultrasonic wave nebulizer
Vibrating mesh Nebulizers
AIR JET NEBULIZER
In air jet nebulizer compessed air is forced
through an orifice, an area of low pressure
is formed where the air jet exists.
A liquid may be withdrawn from a
perpendicular nozzle (the Bernoulli effect)
to mix with the air jet to form droplets.
A baffle within the nebulizer is often used
to facilitate the formation of the aerosol
cloud.
Carrier gas (oxygen) can be used to
generate the “air jet”.
Jet nebulizers are the most commonly prescribed
because they are easy to use and inexpensive.
Disadvantages:
Less portable than inhalers
Delivery may take 5 to 10 mins or longer.
Require power sources, maintanance, cleaning.
Traditional jet nebulizers are often bulky and require an
electrical source, which can be a problem intraveling.
Noisy
ULTRASONIC NEBULIZER
Ultrasound waves are formed
in an ultrasonic nebulizer
chamber by a ceramic
piezoelectric crystal that
vibrate when electrically
excited.
These set up high-energy
waves in the solution, within
the device chamber ,of a
precise frequency that
generates an aerosol cloud at
the solution surface.
Ultrasonic nebulisers (i.e. aerosonic nebulisers) are characterised by fast
nebulisation of medicine particles into extra small size for enhanced
absorption in the very depth of the respiratory system, helping to
increase the effects of medication.
Ultrasonic nebulisers are fast and discreet with reduced noise levels.
They can be used at home and during travel as many modern
ultrasonic nebulisers are not only mains powered, but also battery
powered for convenience.
Car adaptors are also used for nebulisation on the move or for
recharging batteries.
The only drawback is medication restrictions because heat is transferred
to the medication
VIBRATING MESH
NEBULIZER
In this technology a mesh/membrane
with 1000-7000 laser drilled holes
vibrates at the top of the liquid
reservoir, and thereby pressures out a
mist of very fine droplets through the
holes.
This technology is more efficient
than having a vibrating piezoelectric
element at the bottom of the liquid
reservoir, and thereby shorter
treatment times are also achieved.
The high nebulization capacity (>0.25 ml/min) device
offers short inhalation time.
The old problems found with the ultrasonic wave
nebulizer, having too much liquid waste and undesired
heating of the medical liquid, have also been solved by
the new Vibrating Mesh nebulizers.
NEW GENERATION NEBULIZER
AERx
Advantages of the AERx
System
Small hand-held devices
Very short administration
time(typically 1-2 breaths)
Highly efficient, precise
aerosol delivery
Breath control to ensure
reliable drug delivery to lung
Simple to use.
NEBULIZER SOLUTION FORMULATIONS
Nebulizers are designed primarily for use with aqueous
solution or suspension.
Drug suspension use primary particles in the range of 2-
5 microns.
Nebulizer solutions are usually formulated in water,
although other cosolvent for eg. Glycerin, propylene
glycol,and ethanol may be used.
Nebulizer solution pH be greater than 5.0 to show that
bronchoconstriction is a function of hydrogen ion
concentration.
METHOD OF ADMINISTRATION
Nebulized aerosol is introduced to the patient by
compressed air from a device known as positive pressure
ventilator.
A mouthpiece may be inserted in the mouth may be
attached tightly to the face.
A face tent fits more loosely around the patients mouth,
allowing speech.
A tracheostomy mask may be fitted to the patients
tracheostomy tube directly and require T shaped adapter
Face masks should be avoided or sealed very tightly
when anticholinergic drugs are administered to patients
with glaucoma.
Face masks should ideally also be avoided for delivery
of nebulized corticosteroids, to prevent contact with the
surrounding facial skin and eyes
PROCEDURE
Plug the compressor unit into the mains. Connect the
tubing from the compressor unit to the bottom of the
nebulizer chamber.
Unscrew the top of the nebuliser chamber. Open the vial
of drug solution by twisting off the top.
Measure out the correct amount of drug solution and pour
into the nebuliser chamber as is prescribed, following
both the doctors and manufacturer’s instructions.
Check with G.P. or pharmacist before mixing two or
more drug solutions in the nebuliser chamber.
Sometimes the drug solution needs to be diluted.
Add the required amount of normal saline.
DO NOT dilute the drug solution with water. You
need around 4-5ml solution in the nebuliser chamber for
it to work properly.
Screw on the top of the nebuliser chamber and attach the
face mask or mouthpiece to the top of the chamber.
Support the service user to sit up, in a chair or in bed and
keep the nebuliser chamber upright.
Switch the compressor unit on and ask the service user to
breathe in and out as normal. Help the service user to
relax whilst using the nebuliser, (perhaps by watching
television)
Whilst the nebuliser is in use, small drops of drug
solution may form on the sides of the nebuliser chamber.
Knock these droplets back into the drug solution by
gently tapping the side of the nebuliser chamber with a
fingernail.
When the nebuliser starts to 'splutter' the treatment has
finished - this will take between 10 and 20 minutes. A
small amount of solution may be left in the nebuliser at
this stage, but this is normal.
Switch off the compressor unit and disconnect the
nebuliser chamber from the tubing.
Wash hands.
If at any point the service user is uncomfortable or
distressed, stop before starting again.
PRACTICAL ISSUES
Cleaning :
Nebulizers should be cleaned daily in regular usage and after
each use in intermittent use.
The mask, mouthpiece and chamber should be disconnected,
disassembled and washed in a warm detergent and water
solution. The components should be left to dry overnight.
Before reuse, the nebuliser should be run for a few seconds
before adding medications.
Maintenance :
Disposable components such as the mouthpiece, mask, tubing
and nebulizer chamber should be changed every three to four
months.
Compressors require annual servicing by manufacturer or
local service provider
