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?

[stolik19]

My textbook did go on to say to administer a SABA five minutes before a glucocorticoid...I understand the concept but was confused by the responsiveness of the drugs. Thanks!

[sapphire18]

Quote

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

Wow!.

[JustBeachyNurse, LPN]

My pedi patients who are managed by a regional pedi hospital all have MDI with spacer. & mask. Higher effectiveness & compliance. Nebs only used for severe restriction or certain conditions like CF. MDI & spacer even used in the NICU

[baldzilla55]

RT here.... I would like to know why you're giving all those medicines in the first place?

Is the patient in exacerbation from COPD or Asthma?

STOLIK19: WRONG....Inhaled corticosteroids DO NOT decrease mucus production. RIGHT....Brovana should not be mixed with other meds.

JUSTBEACHYNURSE: NONE of those drugs interact with alveoli. They do alleviate BRONCHO-constriction. Bronchus and bronchioles.

FIONA59: Brovana is NOT available in an inhaler. It is nebulizer only.

All of what you are asking can be answered by your Respiratory Therapist. If you dont have them on staff then find one. Very valuable resource for pulmonary disorders and diseases and how they are treated.

Why do I recommend this...Not because I'm an RT but because your querry depends on so many variables.

What type of nebulizer?

Age of the patient?

The different conditions under the umbrella term "COPD"? Emphysema vs. Chronic Bronchitis.

Medication side effects on this particular patient?

With warmest regards....

Baldzilla55

[sallyrnrrt, ADN, RN]

RN and RRT here.....

badzilla, great job....

[CFMomma]

I don’t have any medical schooling background, but my daughter and I both have cystic fibrosis. She takes Levalbuterol, pulmozyme, and hyper-sal, and Flovent and just recently has been prescribed vancomycin as a neb treatment. The RTs have told us to do the treatments in this order:

1. Levalbuterol & CPT (vest)

2. Hyper-sal

3. Pulmozyme

4. Vancomycin

5. Flovent inhaler

I was actually on this blog to try and find out what order she should do her new vancomycin in, but just got a call from the on-call pulmonologist. I thought I would share in case there is someone else giving these same drugs needing information.

I did, however, forget to ask the doc one thing. With the Pulmozyme, you have to use a separate new cup for it. Is the same true for the Vancomycin, or can I use the same cup I used for the Levalbuterol and Hyper-sal? Anyone know?

[ComeTogether, LPN]

On 1/5/2012 at 12:50 PM, 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.

I give albuterol first and brovana second, since its a maintenance med. It should be in the MAR according to how it is to be administered, though.