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what's up today guys welcome back to the
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RT clinic today I'm talking about
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delivering nebulizer medications now
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question is have you ever seen anybody
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take their net like this
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[Music]
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cut to the intro
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[Music]
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we are gonna show today how to give a
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standard nebulizer treatment we call
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this a tena it can be called whatever
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but this is your standard generic
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nebulizer so we're gonna I'm going to
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show you a little bit of how with
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medication in they teach the patient
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their breathing pattern and then some
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parts of your assessment while you're
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watching them take the nebulizer and
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then after so let's get to it there are
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some basic pieces to a nebulizer first
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of course you're going to have the
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nebulizer inside of it as you take off
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the top you see there's going to be a
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baffle in here and so what that's going
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to do is actually going to come through
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this side or air in your case if you're
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at home it's going to come through it's
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going to cause splattering the
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medication it's going to break it up in
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a really small particle size we don't
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like to call it smoke we don't want to
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call it mist we call it nebulized
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medication because that's exactly what
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it is so let me attach that to the next
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piece extremely simple this is a tea as
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you can see it goes right on the top
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we then attach the mouthpiece of course
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when I'm attaching the mouthpiece for
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the patient I make sure I don't touch
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this part that's gonna be in the
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Roundhouse my girls and like to be
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courteous to them so that this piece
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would go on here so I usually in case
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the patient I would just use the bag put
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that on and then we have this piece here
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so you may see a lot of nebulizers that
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just look like this this is our
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reservoir so I'm going to talk a little
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about what this is used for but I like
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to use it because it does allow them to
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get a larger amount of nebulizer
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medication each time they take a breath
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in and then our simple oxygen tubing
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that connects the bottom and runs to the
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flow meter
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there's a standard setup so mouthpiece
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here we have our nebulizer our tea and
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then our extra piece of tubing or risk
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for two so
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at the Texas is a flow meter so this
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necklace right front this is
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specifically from Salter and they're all
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very very similar this is just what we
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use our facility
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this has to have at least and / the /
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the
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the guidelines this is supposed to have
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four liters at least that's that's super
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low so what you're gonna want to run
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most your nebulizers on is eight liters
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per minute okay if you have a home
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compressor you turn it on that's really
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when it's running on maybe a little bit
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lower and put it in the hospital
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we're running enough oxygen in this case
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and we could run top medical air
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actually medical air is does really well
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because it's not gonna mess with our
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pao2 on their blood gas it's not gonna
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give them extra supplemental oxygen if
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they do I need it and especially on our
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Neos our peds we use air in this case
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I'm just going to do with oxygen so I
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would turn this up to six liters you can
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hear it running through there but
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there's no nebulizer medications so shut
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that off to add nebulized medication to
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it we just simply take off this part now
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we're going to add it into here the
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absolute key is that when you run
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medication in these is that you have at
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least three milliliters of volume
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whatever you're doing do not put a
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milliliter two million at least three
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milliliters and I wouldn't go more than
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six in most cases because what it's
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going to affect this particle size and
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we're going to talk about particle size
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a little bit so we have our 5 ml
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normal saline bullet we'll put about 3
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in there
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there we go
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we're going to attach this piece to the
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top and then we're gonna start it up hey
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there four minutes now you hear it
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nebulizing
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so in this case you can see the
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nebulized
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medication is saline in this in this
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part coming out this side and coming out
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this side this is not
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normal this is not cool at all this is a
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rink temperature so it doesn't really
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have much of a temperature to it but as
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you can see it's coming out both sides
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now the key is the service put this in
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their mouth and breathe it in I'm going
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to show you a couple key things to look
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for when they do that so when I hand
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this to a patient what I'll do is I'll
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ask them bike down the mouthpiece and I
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ask him to breathe normal and then every
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four to five breaths take a breath in
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and then let it out the real key is that
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they have a smooth laminar flow and are
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taking their treatment because we want
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to get it down to the lower purse to
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Airways now this is not a mist wherever
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this is not not based nothing like that
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these the nebulizer medication and this
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particle size is three to five microns
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that's really important because that's
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exactly what it takes to get to those
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areas right above your IV line where it
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can fly into those muscles and loosen
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them up and that's what most of them
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well that is what all our bronchodilator
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students so if I hand this up patient
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this is the normal breathing pattern so
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I have that like this right now
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notice a couple of things with this
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first of all when I breathe in and
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you're gonna see the mist go in when I
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breathe out you should see it shoot out
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quickly when I take the breath in this
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reservoir works because I'm not only
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going to get the medication from here
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I'm gonna get nebulized medication
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that's held in here as you can imagine
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we would get less in this case
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because I do not have the reservoir on
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so actually kind of lied to get more
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medication which is great
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one thing you might also want to cut
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your patients with and tell me if you
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can figure out what the problem is here
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[Music]
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[Music]
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the respiratory therapist out there
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probably picking up on pretty quick
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watch the nebulizer medication here some
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patients she'll hand this to them
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they'll put it in their mouth and
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they'll do this breathe through their
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nose
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[Music]
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you see how this isn't moving at the end
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watch when I breathe through my mouth
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[Music]
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one the key is that I always look for
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especially to confuse patients when you
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do that teaching to stay there with them
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and your watch them chest rise like like
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chest excursion so my eyes always goes
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for chest excursion and then I look at
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to see if they're pulling actually
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nebulized medication from the end of
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their pants so that's really important
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to know that they're taking it right if
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they start to fall asleep sometimes well
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you want to make sure they're wake him
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up of course they may start breathing
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into their heads
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[Music]
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getting zero minutes at that time
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because they're pulling air from the
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nose down the whole pharynx and not
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pulling anything is anything from the
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nebulizer
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now you're gonna hear as this thing's
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running hearing hearing a change in the
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sound
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you're the change in the sound it's
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called so many different things call it
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sputtering
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it's really running out of medication is
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what it is now
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once you start to hear sputter these
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particle sizes are no longer three to
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five microns and you should stop the
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nebulizer
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technically that's exactly what you
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should do now though there are a lot of
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patients and we're in customer service
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so a lot of patients that will say
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there's still some medication in there
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and I want you to
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tap it you
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can tap it a knock some of the
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medication off the sides and then be
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they can get one or two extra breaths
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out of work start sputtering against
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that makes the patient happy I go with
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it but technically when it starts to
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sputter the treatment is finished and
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then take really long because I'm using
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the compressed oxygen off the wall but
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it's still running eight leaders so
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what's the more medication there
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[Music]
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so we're running again you can hear the
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change in sound and if I get it closer
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you hear that change really nice smooth
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you can see on the bottom here you see
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the nebulized ceiling
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see it come out see it on my blue shirt
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there
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you can see that we have coming out well
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there if we include this side that's all
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the nebulizer medication coming out so
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there are also a big
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controversy a lot of people you go in
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the room and they say I don't wanna do
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that TV
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the last therapists let me do the mask
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so the mask is this it's an aerosol mask
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let me talk about it a little bit
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not a big fan personally the aerosol
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mask because I like to deliver much of
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the medication as I can because if I'm
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in the room giving the treatment I
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wanted to get the medication and aerosol
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mask works like this it goes all in the
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patient
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and when they take a breath in
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they get medication
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I'm gonna be a lot quicker then get some
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medication from this but what it does
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not encourage them to do is to take
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those specific threat especially the
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deep breath because a lot of times
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they'll put this on patient and they're
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gonna do this
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so they're gonna fall asleep and they're
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gonna have to get the medication their
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way in sure so I strongly recommend
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there are definitely times to use a mask
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but it's a very very rare I encourage
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the patient each time I would really
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like I tell them I'd really like you to
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try to use the t piece for this
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treatment
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absolutely during the day too because
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what it does it makes them take an
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active role in their breathing when
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they're taking the medication
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being more deliberate about it and I
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totally believe it delivers way more
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medication so that's the use of the
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standard manual Iser I
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can't really think of much else I need
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to go over with this thing
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you know there is
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there has been done before which is
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definitely not encouraged blow-by
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treatments now I'll give you an idea
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what blow-by treatment is you'll hear
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this they're heard of this give total
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before so what we would do is we would
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include one side and maybe this would be
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a crying in for something and the rest
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right there so hold these treatments
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and if you have one of your really young
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young ones there obligate those
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breathers don't point their mouth make
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sure you point their nose
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cuz we're gonna take it in their nose
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and we would kind of instead of using
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the bass we would we'll do this now you
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decrease your appendix and deliveries by
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I come now you make a number of but it's
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you decrease a lot so you're not
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delivering quite as much medication so
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blow-by is definitely not recommended
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although you can see when I'm talking
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and I take a breath in it just almost
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makes this area like a little bit of
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reservoir so I can take it in that's
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what a blow by treatment is so if you
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have if you have a young one and you
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have to do it make sure you're aiming
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up look at those breathers
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don't even around him right there right
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there below their nose and that's where
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I try to keep the mist if I have to do
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it but really try not to
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done with your treatment there are some
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other things you need to look at so
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let's say anything has tappet or
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whatever but you see there's still some
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medication in there and every time you
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give medication there's gonna be some of
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it that's not going to be nebulizing so
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it's just not gonna break up the way it
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should what we need to do is make sure
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that is out of the nebulizer and not
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built into the next treatment because it
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will just stay in there and they'll be
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more unnavigable medication and more and
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more and more so we raise out that we're
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is out these or what we especially if
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nothing else you just dump out that name
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is medication that's not being here so a
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lot of times we can shut this off
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open it up like this and with a gloved
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hand you could dump out that over a
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trash bag or something like that so you
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get that medication out of there that's
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just going to sit there for the next
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treatment it's not going to realize the
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next year in sucking nebulized that's
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absolutely normal that happens with this
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type of mini we're going to move to the
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next nebulizer and this one that's going
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to give a higher dosage in a shorter
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amount of time it's similar to a breath
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actuated nebulizer in this case it's
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it's at our nebulizer and I'll show you
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what about it but this one we use a lot
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in the ER or somebody we need to turn
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around real quick this is our standard
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nebulizer if you're getting treatments
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on the floor if you're taking my home
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you're gonna get these these are cheap
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manufactured mass manufacturers so they
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can't be defective so it's just a little
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thing to watch out for one other helpful
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hint now this is just a little Jimmy ISM
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that I do with my nib so when I take a
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nib out of the package the first time
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right for our patient it's a draw I call
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it a dry nib so it's almost always gonna
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run faster the first time then the
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second third fourth or fifth because
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it's dry well I will commonly do with
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the dad when I take it out of the
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package is I will put saline inside of
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it swish it around and then pour it out
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what that does it kind of just starts
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the nebulizer off so it's going to last
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the same amount of time each time your
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patients may complain I've had one
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complaint before where they say
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the nebulizer didn't take the other one
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or the other was last night didn't take
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us long why just changed in that me
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eliezer house so it's very common I'll
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do that I'll take it from a dry nap I'll
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make it a wet nap but sailing in dumper
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and out and then put the medication in
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but I just think it's a patient
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satisfier and it's something to give
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that consistency in the treatment time
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because when you give one of these it's
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going to be really fast compared to what
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they're doing at home and they'll tell
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you over and over and over and over
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again that this is way faster than what
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they're doing at home because we're
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using the compressed air I started
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compressed oxygen on the wall 50 psi
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leaves per minute and they're use a
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little air compressor we're just always
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going to run faster but you don't wanna
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run a lot faster by giving that dry now
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on the first and EV so it's just a
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little helpful hint to think about but
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let's get to the tower now so this
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nebulizer looks a little different
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you still have your nebulizer piece the
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same a little thing they're just built a
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little different here as you can see
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that it has a little one-way valve on
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the top and then the mouthpiece is here
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so the mouthpiece but go on here we're
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gonna run off the same liter flow as
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before so we're running a liters and I'm
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gonna show you a little bit about it it
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delivers you can hear it running now is
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no medication in it so let's piss off
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this was a new name I'm gonna do just
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like I said and the Saline then shake it
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out pour it out and put the medication
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in but this piece comes off the top
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we're gonna add some normal saline
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[Music]
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same those at least three MLS usually up
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to six we can go a little higher than
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that we don't really like to if you're
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going to look at this you're gonna see
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some one-way valves right here you're
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going to see one right there so that's
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gonna help to direct medication and
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really hold large doses in here so they
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get large bills each time let's turn
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this on
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there's the nebulizer running and what
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it's gonna actually do it's gonna fill
00:16:44
this little Tower with
00:16:47
nebulize medications that's ready to
00:16:50
deliver
00:16:52
and also what it does it really helps to
00:16:55
keep up with their inventory flow so
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when they take this in they get a large
00:16:58
dose of it I like the way to hold it to
00:17:01
is a little easier than the teeth have
00:17:02
it kind of goes really nice in your hand
00:17:10
they can kind of do it like that they
00:17:12
want but I still always recommend just
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keeping their mouth
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they blow back through it
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you can see the one-way valve and it
00:17:32
forces that air out that direction so
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but it will nebulize quickly when it
00:17:45
gives some large doses so this is a
00:17:47
patient that is an asthmatic that needs
00:17:50
not just your two point five milligrams
00:17:51
we're going to be adding a lot more to
00:17:54
the treatment maybe five milligrams
00:17:55
seven and a half of ten milligrams so
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large dosages it helps us deposit really
00:18:01
well because they get a lot more and
00:18:03
what they get with the team is so I just
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just wanted to show that a little bit
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and that's how that works you can do a
00:18:09
little messing around here put this
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piece on here
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goes in here and then what do you know
00:18:26
that Google on your masterwork of until
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I feel that masks my big fat butt okay
00:18:31
so I want to do it what the mask I think
00:18:34
it's a waste but whatever it does have
00:18:38
that adapter in case you want to do that
00:18:39
you try to get him to do the mouthpiece
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like I say that makes them take an
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active role and doing their nebulizer
00:18:45
treatment so
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hey guys I think that's all I have
00:18:51
please like subscribe comment to the RT
00:18:56
clinic and put any questions if you have
00:18:58
them thanks for watching I'll see you
00:19:01
also wanna thank the Indiana State
00:19:03
University PA program for the sweet
00:19:06
shirt that I'm able to wear in today's
00:19:10
video thanks guys
00:19:14
[Music]
