Respiratory Therapy Equipment Overview

Capillary Tube and Jet Nebulizer

  • Capillary Tube (labeled as c)

    • Function: Responsible for drawing the liquid up.
    • Description: Clear piece removed from the baffle.

  • Gas Connection (bottom piece)

    • Function: Delivers gas to the nebulizer.

  • Jet Nebulizer (collective labeled as d)

    • Components: Capillary tube, gas inlet, and some liquid (medication).
    • Note: Design and function of the components are similar in both large and small volume nebulizers, though arranged differently.

Gas Inlet and Compression

  • Small Volume Nebulizer Components
    • Gas Inlet: Provides connection for therapeutic gas.
    • Long Capillary Tubing: Extends further in large volume units.
    • Baffle: Larger in size in large volume nebulizers to produce bigger aerosol droplets.

Gas Type for Nebulizers

  • Types of Gas Used
    • Therapeutic Gas: Ideally used for medical purposes, such as oxygen.
    • Air Compressor: Common for home use; operates with room air.
    • Hospital Use: Often utilizes piped oxygen. For emergency situations like severe asthma attacks, can use Heliox (mixture of helium and oxygen).
  • Gas Flow Rate: Required rate for any small volume nebulizer is between 6 to 10 liters per minute.

Medication Application in Nebulizers

  • Liquid for Nebulizers

    • Types of Medications: Most come premixed, commonly in a unit dose.
    • Instruction: Open the container, squeeze the medication into the nebulizer.

  • Droplet Formation and Mist Production

    • Observations: Droplets form and roll back into the solution if baffle isn’t breaking them sufficiently small.
Patient Breathing Techniques

  • Breathing Through Nebulizers

    • Importance: A tight seal is essential around the mouthpiece.
    • Method: Patients should breathe normally, but also take deep breaths occasionally to enhance medication delivery deep into the lungs.

  • Risks with Hyperventilation:

    • Consequences: Hyperventilation can lead to passing out; patients should avoid taking deep breaths throughout the entire treatment.

  • Signs Treatment Is Complete

    • Sputtering Sound: Indicates the treatment is finished; no need for patients to wait for total dryness in the container.

Introduction to Dry Powder Inhalers (DPI)

  • Types of Dry Powder Inhalers
    • Discus Inhaler: Common DPI model.
    • HandiHaler: Another DPI model.
  • Medications: DPIs are used for maintenance medications only; no rescue inhalers exist in this category.
Maintenance vs. Rescue Medications
  • Maintenance Medications:
    • Used regularly to manage conditions (e.g., high blood pressure pills).
  • Rescue Medications:
    • Used in emergencies, such as during an acute asthma attack.

Usage Instructions for Dry Powder Inhalers

  • Discus Operation:
    • The inhaler has a finite number of doses, each indicated on packaging (e.g., 30 days).
    • Method: Open the inhaler, activate the lever to release a dose.
    • Caution: Breathing directly into a DPI is discouraged due to moisture exposure.
  • Storage:
    • Recommend storage outside of bathrooms to prevent moisture damage to the powder.
Steps for Proper DPI Use
  1. Prepare: Show the activation and mouthpiece exposure.
  2. Breathe: Patients should fully exhale before inhalation.
  3. Tight Seal: Instruct to form a tight seal around the mouthpiece.
  4. Hold Breath: Recommend holding breath for five to ten seconds after inhalation.
  5. Exhale through pursed lips: This ensures medication adheres properly.

Metered Dose Inhalers (MDI) Overview

  • Prevalence: MDIs are the most frequently prescribed inhaler for medication delivery.
  • Types of MDIs:
    • MDIs can contain maintenance or rescue medications.
    • Several brands exist, which may differ in appearance but not function.
  • Initial Set-Up:
    • Patients must shake the device and remove the cap before usage.
    • Some devices require priming if unused for over 48 hours.
Using Metered Dose Inhalers
  • Proper Technique:
    • Inhale slowly while actuating the device; coordination is crucial for efficiency.
    • Exhale Before Use: Important to exhale deeply prior to inhalation.
  • Operation:
    • Hold around three fingers away and ensure a wide open mouth.
    • After inhalation, hold breath and exhale through pursed lips to increase deposition in lungs.
Use of Holding Chambers and Spacers
  • Function:
    • Holding Chamber: Allows patient to actuate the MDI and inhale without simultaneous coordination.
    • Spacers: More simplistic devices that may lack a one-way valve.
  • Dosing Aid: They enhance successful medication delivery to lungs.

Patient Education and Compliance

  • Ensuring patients understand how to effectively use their inhalers is critical.
  • Common Issues:
    • Patients often misuse inhalers simply by failing to follow instructions provided.
  • Role of Respiratory Therapists: Emphasize the importance of education in the management of respiratory conditions, encouraging proper technique and understanding of when to use maintenance versus rescue medications, and ensuring proper use of devices to improve adherence and effectiveness.