Nebulizer

[ariessanne]

Hi. If you received an order to administer different nebulizer: albuterol, brovana, pulmicort to a patient, in what order you will administer it?

Would you mix albuterol and ipratropium together or administer it separately?

[sapphire18]

We always mix albuterol and atrovent. As for the others, I'm not sure but am interested to see what others say.

[notmanydaysoff]

Have you checked your nursing drug book for incompatibilities/order of administration?

[jimthorp]

ariessanne said:

Hi. If you received an order to administer different nebulizer: albuterol, brovana, pulmicort to a patient, in what order you will administer it?

Would you mix albuterol and ipratropium together or administer it separately?

Mix them together. They come premixed and it's called Duoneb but some insurance prefer the indivudual drugs due to the almighty $.

[caliotter3]

I've read the package inserts to the meds, most of them say something like it is not established that the med can be mixed. Every nurse I've ever had this discussion with, mixes the meds. I give bronchodilators first. I also take the time to rinse the cup between uses, but that is just me, as no one else bothers.

[ariessanne]

I do administer bronchodilators first, both Albuterol and Bronava are bronchodilators, then corticosteroid (Pulmicort). I'm just curious to know which one between albuterol and bronava should be given first as I can't find any information about this, even in the package inserts. Albuterol is a short acting beta agonist inhaler while Brovana is a long-acting beta agonists (LABAs). Both are on BID, but albuterol is also on prn order.

In our facility, I asked one of the nurses if I can administer Albuterol and Ipratropium together and she said "yes" as long as both are in doctor's order. My intention for asking this is I want to do the right thing. If mixing it will not cause any negative effect or not wrong then why not? it will save me few minutes rather than giving it separately. But like I said, I'm not just after "saving time", because safety comes first.

[DogWmn]

If you can't find the info in a drug book try calling the pharmacist.

[jimthorp]

ariessanne said:

I do administer bronchodilators first, both Albuterol and Bronava are bronchodilators, then corticosteroid (Pulmicort). I'm just curious to know which one between albuterol and bronava should be given first as I can't find any information about this, even in the package inserts. Albuterol is a short acting beta agonist inhaler while Brovana is a long-acting beta agonists (LABAs). Both are on BID, but albuterol is also on prn order.

In our facility, I asked one of the nurses if I can administer Albuterol and Ipratropium together and she said "yes" as long as both are in doctor's order. My intention for asking this is I want to do the right thing. If mixing it will not cause any negative effect or not wrong then why not? it will save me few minutes rather than giving it separately. But like I said, I'm not just after "saving time", because safety comes first.

As I said earlier, you can mix albuterol and ipratropium bromide together. They come together in the drug Duoneb.

Do not mix Brovana with any other medcine in the nebulizer.

[stolik19]

Hello!

I know this is an old thread but since I'm studying nebulizer and respiratory meds right now, though I'd chime in! From what I'm reading, glucocorticoids (budesonide) suppress inflammation, decrease airway mucus production, and increase the number of bronchial beta 2 receptors as well as their responsiveness to beta 2 agonists...which are your bronchodilators (ie Albuterol, Brovana). This leads me to believe that the glucocorticoid should be given first to enhance the effects of the albuterol/brovana. The brovana being a LABA, should be on a fixed schedule and may not coincide with the other nebulizer schedule at all times but must never be given alone (without the aid of a glucocorticoid) due to possible asthma-related death.

[JustBeachyNurse, LPN]

Bronchodilator first to open the airway, inhaled corticosteroid second. This way the airways are as open, non-constricted as possible so that the corticosteroid can reach the greatest surface area & offer maximum anti inflammatory benefit.

[JustBeachyNurse, LPN]

LABA are always on a fixed schedule (usually q12 h)

SABA are given first as they are rapid acting and open the constricted airways. May give with anticholinergenic like ipratropium to further open airways.

Corticosteroid always after SABA so they are more effective. It's useless to give corticosteroid if constriction/ restriction is present as the drug won't reach the smaller bronchioles & alveoli where they are needed until the SABA does it's job as a bronchodilator

[Fiona59]

Nebulizers are no longer used in my hospital. Everything is via inhaler. Haven't seen a nebulizer in probably five years.