Clinical Reference Systems: Pediatric Advisor 10.0

Many medications are most effective when inhaled directly into the lungs. To be inhaled into the airways of the lungs, medication must be changed from a liquid to a fine mist. To create this fine mist at home, you need a nebulizer and an air compressor. A nebulizer is a plastic container that breaks liquids into a fine mist using a jet of air. The compressor, run by electricity or battery, provides the jet of air to the nebulizer.

How is the home nebulizer used?

1. Place the compressor on a hard surface. Make sure the filter is free of dust and dirt. If it is dirty, rinse it with water and then dry it. Plug in the compressor.

2. Place the prescribed amount of medication(s) into the nebulizer with a dropper or syringe. Most medications can be mixed together, but if you have a question don't hesitate to ask.

3. If prescribed, add salt water (normal saline). If you should run out of normal saline, 1/2 teaspoon of water may be substituted.

4. Attach the nebulizer to the compressor tubing. Turn the power on. (The medication will immediately begin to be nebulized.) Place the mouthpiece in the mouth and breathe in and out through the mouth until all the medication is gone. If the child is able, tell the child to take an extra deep breath every 10 breaths or so, hold that breath for 10 seconds, and then breathe out slowly. This technique permits the medication to stay in the lungs longer for better effect. With smaller children, it may help to hold their nose closed to get more medication into their lungs.

If a child is too small to use a mouthpiece, hold the nebulizer 2 to 4 inches in front of the child's mouth. Or you may use a mask, which can be secured loosely over the nose and mouth so the child does not become frightened. If a "T-piece" is used on the top of the nebulizer, block one end with tape or with your thumb so that more mist will be directed at the child.

Most nebulizers work best in an upright position. If the mixture has coated the sides and isn't being nebulized, gently shake the nebulizer occasionally during the treatment. An average treatment takes 10 to 15 minutes. The treatment is over when all the medication is gone and the nebulizer makes a constant sputtering noise.

Some children cough up mucus after breathing treatments. Observe the mucus color and thickness. Normal secretions are usually thin and white or clear. Thick and sticky mucus that is yellow or green may indicate infection. Call your doctor to report a change.

If your child needs more treatments than prescribed by your doctor, or if the treatments do not improve the symptoms, call your doctor.

How and when should the nebulizer be cleaned?

After each treatment, rinse the nebulizer, mouthpiece or mask, and T-piece under hot running water. Shake off excess water, place the pieces face down, and let them air dry. Store the pieces in a clean bag. It is not necessary to clean the compressor tubing.

A more thorough cleaning is necessary if more than three to four treatments with the nebulizer are given each day. Use a safety pin to clean out the tiny hole of the tower of the medicine cup on the nebulizer to prevent clogging of the nebulizer jet. Prepare a solution of one part white vinegar and two parts water. Once a week soak the nebulizer in the mixture for 30 minutes, rinse each piece thoroughly under hot running water, place the pieces face down, and let them air dry. Store the pieces in a clean bag.

What special instructions should be followed?

Your doctor has prescribed nebulizer treatments to be given ______ times a day. The medication(s) to be used is(are) _______________________________ (the amount is ___________), and is mixed in _____ ml of normal saline (other: _________________________).