Administering Medication via a Small Volume Nebulizer

Goal: The patient receives the medication via a small volume nebulizer using the correct technique.

1. Gather equipment. Check each medication order against the original order in the medical record, according to facility policy. Clarify any inconsistencies. Check the patient’s chart for allergies.

2. Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.

3. Perform hand hygiene.

4. Move the medication cart to the outside of the patient’s room or prepare for administration in the medication area.

5. Unlock the medication cart or drawer. Enter pass code and scan employee identification, if required.

6. Prepare medications for one patient at a time.

7. Read the CMAR/MAR and select the proper medication from the patient’s medication drawer or unit stock.

8. Compare the label with the CMAR/MAR. Check expiration dates and perform calculations, if necessary. Scan the bar code on the package, if required.

9. When all medications for one patient have been prepared, recheck the label with the CMAR/MAR before taking them to the patient.

10. Lock the medication cart before leaving it.

11. Transport medications to the patient’s bedside carefully, and keep the medications in sight at all times.

12. Ensure that the patient receives the medications at the correct time.

13. Perform hand hygiene and put on PPE, if indicated.

14. Identify the patient. Usually, the patient should be identified using two methods. Compare information with the MAR/ CMAR.

a. Check the name and identification number on the patient’s identification band.
b. Ask the patient to state his or her name and birth date, based on facility policy.
c. If the patient cannot identify him- or herself, verify the patient’s identification with a staff member who knows the patient for the second source.

15. Complete necessary assessments before administering medications. Check the patient’s allergy bracelet or ask the patient about allergies. Explain what you are going to do, and the reason for doing it, to the patient.

16. Scan the patient’s bar code on the identification band, if required.

17. Remove the nebulizer cup from the device and open it. Place premeasured unit-dose medication in the bottom section of the cup or use a dropper to place a concentrated dose of medication in cup and add prescribed diluent, if required.

18. Screw the top portion of the nebulizer cup back in place and attach the cup to the nebulizer. Attach one end of tubing to the stem on the bottom of the nebulizer cuff and the other end to the air compressor or oxygen source.

19. Turn on the air compressor or oxygen. Check that a fine medication mist is produced by opening the valve. Have patient place mouthpiece into mouth and grasp securely with teeth and lips.

20. Instruct patient to inhale slowly and deeply through the bmouth. A nose clip may be necessary if the patient is also breathing through the nose. Hold each breath for a slight pause, before exhaling.

21. Continue this inhalation technique until all medication in the nebulizer cup has been aerosolized (usually about 15 minutes). Once the fine mist decreases in amount, gently flick the sides of the nebulizer cup.

22. Have the patient gargle and rinse with tap water after using the nebulizer, as necessary. Clean the nebulizer according to the manufacturer’s directions.

23. Remove gloves and additional PPE, if used. Perform hand hygiene.

24. Document the administration of the medication immediately after administration.

25. Evaluate patient’s response to medication within appropriate time frame. Reassess lung sounds, oxygenation saturation if ordered, and respirations.