SVN, MDI, DPI -1410 Check Off

how much of the aerosol actually reaches the lungs

10%

where does the aerosol go that is not in the lungs?

the GI tract/esophagus

what % of the aerosol does not reach the lungs

90%

what is the particle size that reach the lower airways

2-5 microns

SVN

small volume nebulizer

an SVN can be used by a

trach collar, mouthpiece, and mask

what psi is an SVN

50

why would a patient use an SVN rather than a MDI

SVNs are easier to coordinate

hazards or complications of SVNs

drug reaction, infection, airway reactivity, drug re-concentrtion, eye irritation

commonly used SVN medications and dosages

albuterol (2.5mg)

Levalbuterol (1.25mg)

Atrovent (500mcg)

different types of SVNs

1. continuous neb with simple reservoir (6-in tubing is the reservoir) *what is in the backpack

2. continuous nebulizer with a collection reservoir bag (Circulaire II) while the patient. is exhaling, medication goes into the bag

3. breath enhanced nebulizer (Salter) uses vents & one-way valves to minimize medication waste into the air

4. breath-actusated nebulizer (AeroEclipse II) generates aerosol only during inspiration

5. Vibrating mesh nebulizer (Aerogen) does not require a gas source, majority of particles are in therapeutic range

MDI

metered dose inhaler, most commonly prescribed aerosol and most commonly misused

what helps the accuracy of an MDI?

spacer/space holding chamber

advantages of MDI

1. compact

2. portable

3. easy to use

4.multiuse convenience

why should you warm the MDI canister?

to avoid cold aerosol hitting the back of the throat and stopping inhalation

why should a patient rinse their mouth after an MDI or steroid treatment?

to avoid thrush and plaque build-up

what type of breaths do the MDI require?

SLOW DEEP breaths

complications of MDIs

1. drug reaction

2. infection

3. airway reactivity

4. risk of abuse

most commonly delivered meds via MDI

1. albuterol

2. atrovent

3. symbicort (steroid)

DPI

dry powder inhaler

advantages of DPI

convenient, less coordination required (compared to MDI)

DPI procedure

1. Check order ****always

2. gather equipment

3. wash hands

4. introduce self to pt.., confirm pt. ID, explain procedure

5. pre-medication assessment (hr,rr,bs,spo2,peak flow)

6. assemble device *device should be in upright position when loading med

7. instruct pt. to exhale away from device, close lips to make a tight seal and breathe in forcefully through the mouth QUICKLY

8. intruct pt. to rinse mouth and spit out

9.confirm pt. understanding

10. post-medication assessment (hr,rr,bs,spo2,peak flow)

11. instruct pt. to cough

12. disassemble equipment

13. wash hands

14. chart

commonly used DPIs

1. advair (diskus)

2. spiriva (HandiHaler)- meds look like pills

3. Breo

peak flow

gives you a baseline of where the patient is at before and after treatments

nebulizer care between treatments

1. shake dead volume from cup

2. rinse cup with sterile or distilled water

3. air dry

cleaning nebulizer

1. wash hands

2. wash nebulizer and mask in soapy water daily

3. rinse and air dry

disinfecting nebulizer

1.boil in microwave in water for 5 min

2. dishwasher top rack

3. soaking solutions

spacer care

1. clean every 2 weeks as needed

2. disassemble device for cleaning

3. soak spacer parts in warm water with liquid detergent

4. shake out and remove excess water

5. air dry in vertical position

* do not towel dry the spacer as this will reduce dose delivery

6. reassemble when dry