January 27, 2023

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What is up today guys we have a video today about continuous nebulizers so i’ve got a low volume i’ve got a high volume i’m gonna give you the rundown on how to set this thing up ready cut to the intro let’s get a nuts-and-bolts sending up a large-volume nebulizer and a small volume nebulizer with the proper amount of drug that’s going to nebulize up with a

Proper amount of time this should be review for most but it’s good to review stuff so i got the two products here both of them are from vie air which used to be caref eugen not that that matters because they are all measured the same way so let’s first start with a high volume nebulizer kaval you mute nuh nebulizer large volume nebulizer or whatever you’d like to

Call it but there’s one important thing if i’m new in a facility and i’m going and i’m asked to set up a high volume nebulizer they all work the same it’s not that complicated but one thing i need to know i need to get my paper out so don’t just take the paper and throw it over and let it go underneath everything else no you need the paper because we have some

Very important aspects to it the most important aspect of this is to know what the output is now you have this really nice cheater on here of course that shows you all the different amounts of drugs and whatnot but what i’m looking for is right here under number 4 under number 4 right there if i can get it to focus you’re gonna see at a liter flow of 11 liters

Per minute it’s gonna output 30 mls per hour let’s make this super easy so this is really nice and you can also see at the top of this it says right here at the very top it says misty misty finity continuous dose of 11 liters per minute so this is a dosed protocol but we know how much volume is needed right because if we run it to run for an hour we need to have

30ml zin if we run to run for two hours we need to have 60 ml zin it and so on and so forth running eleven litres per minute so what you’re gonna see here is you’re going to have markings on the side of it so we have markings on the side of this of ml marks so we have 30 90 150 and 210 then it maxes out remember it’s gonna debut lies that 11 liters per minute 30

Mls so the first thing we’re going to do absolute easiest thing to do is we’re going to use this right here as a gauge so if the position wants 10 milligrams of medication so 10 milligrams a standard i bureau does is two point five five we want to do ten we want to put we’re gonna take this very easy we’re gonna take a two point five a two point five a two point

Five and a two point five and we’re gonna take and fill the rest of it up with normal saline up to thirty and then we’re gonna run it we didn’t have to look at this thing at all i mean this is nice right but there’s a quick way to do these type of things so if they want it to run for two hours and they want twenty milligrams about beat are all over two hours or

Ten milligrams per hour for two hours it’s a long nap but that’ll work we’re gonna take and put one two point two point five two two point five s three four five six seven eight that will total twenty milligrams of albuterol for that two-hour nap that the physician was twenty milligrams we would fill it up to the 60 mark so that’s going to be halfway between the 30

And the 90 and then running at 11 liters per minute that’s going to nebulize 10 milligrams for first hour 10 milligrams for the second hour total volume of 60 mls so really an easy way to kind of do this without looking over here and going through and this is i think it’s slightly confusing what you need to know as a review need to know your leader flow like aisle

Number four here and your output on that leader flow after that everything can be calculated in the hour so outputs are in milliliters per hour so that is your large volume nib so when would you use a large volume inverse a small volume personal preference honestly you have to run this question you run this in right through here you’re right cork it tubing off

Of this to a an aerosol mask this can actually screw into the flow meter and it’s going to nebulize so if you think that they’re gonna like that extra kind of miss that nebulized fluid then that will work really well and if you’re doing it for an hour i prefer these just because i like the high output of them now my outputs really nice it looks like a continuous

Nebulizer when i walk in the next one is a small volume nebulizer and i’ll show you that a little bit but this is my preference just because to me it feels like they’re on a continuous nebulizer next one is this small volume low flow nebulizer and this is specific for long treatments too so it’s considered a continuous nebulizer so but the weird thing about it is

If you look at it it doesn’t look a whole lot different than at standard n except for it doesn’t come with a mouthpiece so this could go in go straight into a mask but you can see this nib is very specific in the way it’s made because it’s gonna have a low volume low flow and it’s going to deliver the medications over a long period of time if you look at this

Look at the side of it we looked at the markings on there 10 is a max so 10 mls is the max on this low volume nebulizer so we have our tubing here this is interesting if you ever notice this before so this side goes the flow meter this side goes to the nib and the one that goes to the nib is very very stiff so i think it’s just so you can kind of do that plastic

On plastic thing when you put it in you push them and then get a little a little arty twist there to make sure that it’s held on tight so it’s not popping off so if you notice that if you ever see somebody maybe rookie put this part on there and try to shove this thing onto the flowmeter it’s kind of funny but it works usually alright so let’s get into what does

The first thing we want to know we got kanae-chan of eliezer i want to get the paper out and i want to look at two things what’s my output per hour at what flow so open the paper up scan through the whole thing open up these instructions they’ve got a lot of stuff on here but where i found those it’s got some really interesting stuff on the back see if it actually

Looks a particle size for all y’all interested in that and the particle size delivered you know we’re looking ideally for that 3 to 5 micron they’re saying 1 to 5 micron but anyway what it comes down to as i look at this entire thing and the most important information is really right down here at the very bottom at this point right here you’re gonna see where it

Says that the dose delivered for 2 liters per minute is it’s before mls and performance to be 10 ml so that’s kind of generic settings but this is made for the one hour treatment this is not made or the half hour treatment this is not made for multiple hours of the time this is also low flow so you’re not going to give much fio2 if your patient requires more fio2

You’re gonna need these a large volume nib so lower fio2 s so if we’re gonna go for a low flow which is going to be 2 liters per minute our max fill is going to be 4 mls so if the physician orders 10 milligrams of albuterol over 1 hour and you’re gonna run this on two liters you’re going to need a 5 total volume of for mls so you can’t use unit doses so you put

Unido send you to know doses in there’s gonna be six mls me too much gotta use concentrates so we use a half ml concentrate to 0.5 sorry 2.5 2.5 is 57.5 and then one more so we have four of them and those four is going to make ten milligrams inside of here with the total volume of two you like i put two more mls and you can run it to liter so it should last for

An hour they’re saying 68 ish minutes so if we wanna do the same thing but instead of two liters we run them around four liters we need a total volume of ten so we put our concentrates in and then we’d fill it up to ten with the rest of our normal saline so really important to know what your volume is related to your flow when you’re delivering these continuous

Nebulizers i would call this more of a large volume nebulizer you know the bonuses are i think it’s easier to feel because you’re not you’re looking at this versus versus this and you can dilber more fio2 of this if your patients requiring that at this time if you wanna keep the fio2 is lower keep the footprint a little smaller use these at two liters you’re going

To put four ml’s total and at four liters you’re going to put 10 mls total you can’t really run this i guess you could run it for two hours on two liters you can run this for multiple hours because remember the output is 30 mls per hour and it looks like you can get you can probably about seven hours in there at least because we got 210 ml so i’d be a long nip but

And it’s probably very variable after seven hours of what your nebulizing so just so you know this is continuous nebulization just and continuous nebulize i’m a big fan of them because all of our patients are taking their standard dose up beuter all and do it or do it as a home two point five milligrams and when they get sick they take them every four hours well

That’s giving them another one when they come to the er or when they’re admitted this is really too much i don’t believe i really believe you have to start them with a much higher dose to kind of get them opened up if you will because they’ve been delivering this 2.5 hundred four hours and we just thought about 2.5 s be like what what are we really doing so a big

Fan of continuous nebulizers and even high doses on continuous nebulizers because that meteorologist kind of increases it perpetuates itself so if the more you add yeah you’re gonna get more side effects but and you’re gonna get the hectic rd of the shakes and all that kind of stuff but you’re gonna activate more of those receptors that are there likely to loosen

Up on the airway so a big fan of continuous nebulizers giving large doses over an hour and then assessing improvement after that point sometimes a good continuous nebulizer can turn a patient around so maybe they don’t have get admitted so there’s some things to think about remember to look at your total output from any of your instructions on these but that’s

Going to run down up continuous nebulizers thanks and i’ll see you next time

Transcribed from video
RT Clinic: Tips for Setting up Continuous Nebulizers By Jimmy McKanna – RT Clinic