If you want 15 mg /hr, 15/5 = 3, so give 3 mL of albuterol for each hour needed. If you want 2 hours of nebulizer, use 6 mL of albuterol, if setting up a 4 hour neb, use 12 mL of albuterol.
Then add NS to equal total output rating by particular Nebulizer used.
For multiple hour continuous nebs, assess the patient every 1-2 hours.
PURPLE HEART NEB
Can be run at 10 or 15 L / min, although typically 10 L/min is used.
At 10 L/ min the output is 30 ml/hr
At 15 L/ min the output is 50 ml/hr
Typically set for 4 hour increments.
If using flow of 10 L/min the total output would be 120 ml because at 10 L/min 30 ml/hr is the output, so 30 times 4 gives you 120 ml of output over those 4 hours.
The Max amount that can be in a purple heart neb is 240 mL
Example: order for 10 mg continuous neb for 4 hours
Check order
Convert mg to ml for albuterol amount (10mg = 2 ml) and multiply by 4 (2 * 4 = 8ml).
Draw up 8 mL of concentrated albuterol and place in the purple heart.
Take a bottle of normal saline and fill to the 120 mL line.
Place corrugated tubing from purple heart to aerosol mask and place on patient and turn flow to 10 L/min ran off of a blender.
We drive the Nebulizer via a blended gas source as opposed to off the wall as to monitor oxygen demand and wean FiO2 when applicable for target spo2.
GREEN CONTINUOUS NEB
This is the nebulizer most used for continuous nebs in the emergency department.
Max fill time is 1 hour
Its ran at 10 L/min of flow
Set-up
Check order
Obtain ordered dose of concentrated albuterol and deposit it into the neb
Take normal saline and fill up the cup to the max fill line
Put the top on the neb cup and the mask after that. (non-valved mask)
Plug in the tubing and turn to 10 L
Place on the patient.
CONTINUOUS AEROGEN NEB
Placement: dry side of the heater
We ran studies at UT research center that showed the neb deposition with our system and circuits were very close when placed on the dry and wet side of the heater. Placement six inches from the Y showed very poor deposition.
We place them on the dry side so the aerosol will get heated as it runs through and thus not affecting our airway temps.
This allows us to eliminate the frequent errors of turning heaters off and forgetting to turn them back on with our Nebs.
Always keep the med cup in an upright position to ensure liquid is flowing toward the vibrating mesh
When set to continuous mode the nebulizer output is 12ml/hour
Continuous medication delivery should be done via a syringe pump and set for no longer than 4 hours
Example of set-up: Order for 15 mg/hr continuous neb
Check order
Take the amount of albuterol ordered, convert to mL/hr and multiply by 4, then subtract that from 48 to give you the amount of normal saline needed. EX. 15mg = 3mL /hr, 12 mL for 4 hr. 48-12 = 36 mL normal saline.
Plug in aerogen external battery (Will not work in continuous mode if not plugged in)
Next, fill up the syringe and connect to medication supply tubing.
Place syringe into syringe pump and medication tubing stem into aerogen.
Turn on the pump.
Press the continuous picu button (3), when the screen changes hit the next button, then you will see the volume/time button (5), press that.
It will ask for syringe size, which should be 60.
Next it will ask the volume (48), and then time (4 hr).
Confirm the output will be 12 mL/ hr when the next screen pops up.
Then prime the med tubing until the medication is flush with the end of the stem inside the aerogen med cup.
Hit start (when the lights start concurrently cycling through it is working).
Last, but not least, hold down the power button on the aerogen generator until the light switches to the continuous side.