Aerosol Guide - AARC.org

Technique Box 1. Steps for Correct Use of Nebulizers (continued)
General Steps To Avoid Reduced or No Dosing for All Nebulizers: When using nebulizers, the
following steps should be used in order to avoid reduced or no dosing during aerosol treatment.
The patient should:
1. Read and follow the instructions.
2. Make sure that the nebulizer is properly assembled.
3. Make sure that the nebulizer is cleaned and dried between uses.
4. Make sure that the nebulizer operated in its proper orientation.
Troubleshooting
Problem with Jet Nebulizers: Absent or Low Aerosol
Causes
Solutions
Loose or unattached connections
Check the connections and make sure that they are
properly attached.
Inappropriate flowmeter setting
Check the flowmeter setting and adjust the flow
if it is not appropriate.
Obstruction in the orifice of the
Check the orifice of the jet nebulizer and
jet nebulizer
clear obstructions when needed.
Problems with Mesh and Ultrasonic Nebulizers: The Unit Does Not Operate
Causes
Solutions
Incorrect battery installation (seen in both Check the battery installation and reinstall if needed.
mesh and ultrasonic nebulizers)
External power source connection Check the connections with the AC adapter
(seen in both mesh and
and the electrical output.
ultrasonic nebulizers)
Overheated unit (seen in
Turn off the unit, wait until it cools
ultrasonic nebulizers)
down, and restart the unit.
Incorrect connection of the control Check the connections with the control
module cable (seen in mesh
module cable and attach them properly, if
nebulizers)
needed.
Malfunctioning electronics (seen in both Replace the unit.
mesh nebulizers and
ultrasonic nebulizers)
When Does the Treatment Need To Be Ended
Nebulizers are commonly used for intermittent short-duration treatments and typically have a set
volume of drug formulation placed in the medication reservoirs. The drug remaining in a nebulizer
after therapy ranges from 0.1 to 2 mL. 18 Whereas some respiratory therapists and patients tap the
nebulizer in order to reduce dead volume and increase nebulizer output, 40 others continue aerosol
therapy past the point of sputtering in an effort to decrease dead volume. 18 Some nebulizers will
sputter for extended periods of time after the majority of the inhaled dose has been administered.
Evidence suggests that after the onset of sputter, very little additional drug is inhaled. 18,41 Because
the time it takes to administer the drug is a critical factor for patient adherence to therapy, some
clinicians have adopted recommendations to stop nebulizer therapy at, or one minute after, the
onset of sputter. Newer nebulizers may use microprocessors to monitor how much dose has been
administered and automatically turn off the nebulizer at the end of each dose.
Cleaning: Please refer to the Infection Control section on pages 48–50 for the cleaning instructions
of small-volume nebulizers.
20 American Association for Respiratory Care A Guide to Aerosol Delivery Devices for Respiratory Therapists, 3rd Edition © 2013