Nebulizer and Oxygen via nasal cannula

Specialties Pulmonary

Updated:   Published

Can you give a nebulizer treatment to a patient with oxygen via nasal cannula at the same time?

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Yes, but I usually take it off to give their nose and ears a little break. But many pts say to just leave it in. There is no real reason why you can't

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Thanks Daisy_08!

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Specializes in Emergency, Telemetry, Transplant.

I would be a little concern if they were a COPD patient about over oxygenating them. What I like to do, if there are multiple O2 "hookups" in the room, I leave the NC on the pt and attached to the wall, but turn off the O2. I then use my other O2 source to attach the neb.

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Sure if you want to decrease the amount of medication given to the patient. The purpose of a nebulizer is to get the medication to the lungs. If the nares are plugged with nasal cannula prongs, unless they breathe only through their mouth, less than half of the 20% of the medication given by a face mask will be wasted. To give medications you need to do the most effective method. Try thinking of this as a therapy rather than just a task.

Guide to Aerosol Delivery Guide

http://www.aarc.org/education/aerosol_devices/aerosol_delivery_guide2.pdf

I also would not worry about "over oxygenating" a patient with a 10 minute nebulizer but that is a good reason to remove the NC.

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I"m an RT. I usually just leave in the cannula. I always try to run my nebs off RA for every patient, just because I"m too lazy to start another O2 hookup.

For COPDers, (or almost any patient for that matter) you are NOT going to over oxygenate them with a 6 or 8 liter nebullizer running plus a 2-4 liter cannula. Please, please do not worry about "overoxygenating" a COPDer! In all the repiratory therapists I've ever talked to about this issue, only 1 has actually seen it happen - it is so, so so extremely rare. And it happens *very* quiickly. Like, you turn up the O2 and less than a minute later the patient starts to get sleepy and is less responsive. Then you just turn down the O2 and watch them perk right back up again!! It's not as scary as it sounds. I have end stage COPDers on 100% O2 all the time. Never, ever withold oxygen from a patient that needs it!

This is sometimes a big problem at my hospital. I know you nurses mean well, but some of you focus way to much on this "over oxygenating" theory (and it IS just a theory, remember!). I've gone into patients' rooms where they're wearing a non-rebreather at 4LPM. That's doing WAY more harm than good - the patient is slowly suffocating! Give some o2! :)

I've drawn gases on COPDers where they're PaO2 is like 300 or even higher and they've all turned out just fine. :) (usually from being on bipap or vent, rarely NRB's just for the record).

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Our neb machines are RA, so I leave the nc on. If they were getting O2 via the mask, I'd take it off.

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Being a Respiratory Therapist and a Paramedic, I am a big advocate on using a nebulizer mouth piece over a mask. (I use both oxygen or air...what every is available). When using a mask with a SVN, you are only giving about 10% of that medication to your patient because of: the SVN particles size that is being delivered, the patient's long expiratory time (Asthma/COPD), medication waste do to blow out from the mask, and not being able to taken in a deep breath (breath-by-breath/inspiratory) because of low flow being used. Then add in their nares being blocked by the nasal cannula, snot, NG tube, and the purpose of our nasal airways are to filter/clean out foreign particles. This is why we are giving so many PRN and back-to-back treatments.

Today's "Best Practices" are the "3" H's 1. High doses Albuterol, 2. High Flow nebs, and 3. Hour long continuous treatments.

JT, BSRRT-ACCS, MPS, EMT-P

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