saline nebulizer

vampiregirl, BSN, RN · Mar 1, 2011

Do you have an physician order or is there a protocol in place for the saline nebs (such as administering humidified O2 via mask)?

charleygirl · Mar 1, 2011

no nothing. this is a very busy division of the ED with no respiratory therapist and we do our own nebs. the only protocol in place is for respiratory distress and this allows for 02.

nothing in place for saline neb blow by. My question is do we need a MD order for this??

GreyGull · Mar 1, 2011

For you to be able to do a charge with nebilized saline as a treatment, you should have the appropriate order from a physician with the specific concentration and indication for the saline. Depending on the RT code, you may also have to meet the CMS guidelines if the code falls within a "therapy" with appropriate documentation. If it is just for the equipment or medication then no problem. However, if saline is used as a "treatment", it is consider a medication and should be documented as such. You might also check your policy for initiating a "treatment". Saline is used as a treatment in some patients but usually with higher concentrations of saline. Sometimes a heated 0.9% saline neb will be used but with a specific order for indication and time. The benefits of a 5 minute 0.9% NaCl neb without additional medication is controversial. You should have good documentation with an order for this if you are charging with a med or therapy code or even the nebulizer equipment.

For humidification with oxygen, including blow by, sterile water is used. The standard nasal cannula O2 humidifier charge may be included in the O2 setup code or a separate one from the supply.

Esme12, ASN, BSN, RN · Mar 1, 2011

If you require an order for O2....which you do...you need an order for the O2 saline blow by. Administering blow by 02 in an ED with saline is standard treatment on pedi patients as they are much more willing to tolerate blow by versus mask. Cool mist treatments are common to administer supplemental 02 in the ED but irt requires an order just like any other 02.

Beyond your scope of practice? NO.....who told you that? Check your ED triage/policies and procedures for resp. distress and 02 administration I'm sure you'll find it there if not then you need to make a policy but beyond your scope of practice.....NO it is well within your scope to give O2.

GreyGull · Mar 1, 2011

If you require an order for O2....which you do...you need an order for the O2 saline blow by. Administering blow by 02 in an ED with saline is standard treatment on pedi patients as they are much more willing to tolerate blow by versus mask. Cool mist treatments are common to administer supplemental 02 in the ED but irt requires an order just like any other 02.

Do you use saline instead of sterile water with O2 delivery for all of your pediatric patients?

We (RNs and RTs) can add a sterile water humidifier to almost any oxygen device (except masks that are not aersol) if just for humidificaton without an order but if it is for a specific "therapy" such as cool mist for croup or a saline tx for secretions, there must be a specific order.

MunoRN, RN · Mar 1, 2011

If it's used for the purpose of a medical treatment then you do need an order, if it is for patient comfort then you do not as long as it does not significantly alter normal body processes.

Whether or not something is a medication or drug is defined by it's purpose or action, not by the substance. IV NS is sometimes a medical treatment, and therefore requires an order, and sometimes used for maintenance of an IV, such as flushes which actually do not require a physicians order. Although it's a widely held myth, you don't need an order for things like lidocaine jelly for foley insertion either, since it's purpose is for patient comfort, not to diagnose or treat a medical condition or disease process.