NEBULISER THERAPY

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NEBULISER THERAPY

• Intersurgical

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NEBULISER

• From the Latin nebula, mist

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WHAT IS A NEBULISER?

• A device for converting a liquid into a mist of
  fine particles (aerosol) which may be inhaled
  directly into the lungs

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AIMS OF NEBULISER THERAPY

• Deliver a therapeutic or diagnostic dose of drug
• In the form of an aerosol of respirable particles
• In a short space of time (5-15 minutes)

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ADVANTAGES OF INHALATION THERAPY

• Selective
• Rapid onset of action
• Lower dosage
• Good patient/clinician compliance
• Home treatment possible

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DISADVANTAGES OF INHALATION THERAPY

• Inefficient
• Not suitable for some patient groups
• Home treatment requires the purchase and
  maintenance of a compressor
• Coordination required
• Drug wasted

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Non Nebuliser Inhalation Devices
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MDI - Advantages

• Convenient
• Cheap
• Portable
• No drug preparation required
• No contamination
• Can use on intubated patients

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MDI - Disadvantages

• Patient activation required
• Patient coordination essential
• Large pharyngeal deposition
• Difficult to deliver high doses
• Use CFCs

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MDI Spacer - Additional Advantages

• Less patient coordination required
• Less pharyngeal deposition

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MDI Spacer - Additional Disadvantages

• Increased cost and bulk (than MDI alone)

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DPI - Advantages

• Less patient coordination required
• Breath activated
• Breath hold not required
• No CFCs required

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DPI - Disadvantages

• High inspiratory flow needed (gt 30 lpm)
• Some pharyngeal deposition
• Difficult to deliver high doses
• Cannot use on intubated patients

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USE OF NEBULISERS IN CLINICAL MEDICINE

• Diagnosis
• Lung Ventilation Imaging Radioisotopes
• Treatment
• Airway Obstruction Bronchodilators,
  Steroids
• Infection Antibiotics
• Abnormal Secretions Mucolytics

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DEFINITIONS

• Aerosol Output
• Nebulisation Time
• Efficiency
• Respirable Output
• Residual Volume

• Mass/minute of particles in aerosol form
• Start of nebulisation until cessation of
  continuous nebulisation
• Particles lt 5 microns ()
• Respirable Fraction times
• Aerosol Output
• Volume remaining at cessation of continuous
  nebulisation

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DEFINITIONS CONT.

• MMD
• GSD

• Particle diameter at which 50 of the aerosol
  mass is lower and 50 is higher
• Indicates the spread of the size of the particles

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Cirrus Hot Top
Micro Cirrus
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TYPICAL NEBULISER EFFICIENCY
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GENERAL INDICATIONS FOR TREATMENT WITH NEBULISERS

• Absolute
• Need to target the bronchi or alveoli
• Too sick/incapable to manage hand held inhalers
• Drug not available in hand held inhalers

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GENERAL INDICATIONS FOR TREATMENT WITH NEBULISERS

• Relative
• Need for a large drug dose
• Patient preference
• Practical convenience

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TYPES OF NEBULISER

• Jet Relies on gas flow and the venturi
  effect to atomise the liquid. Needs a
  baffle to remove large droplets
• Ultrasonic Uses a high frequency source to
  vibrate the fluid. Droplets released from the
  standing waves generated
• 
  
  

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Sonic Nebuliser
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JET NEBULISER KIT COMPONENTS

• Energy Source
• Conducting Tubing
• Nebuliser
• Administration Device

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Conventional Jet Nebuliser
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Cirrus
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CIRRUS PERFORMANCE

• Aerosol Output
• Nebulisation Time
• Efficiency
• Respirable Output
• Residual Volume

• 0.31g/min
• 2 mls in lt10 mins
• 76 (2-5µ)
• 0.24 g/min
• 0.9 mls

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CIRRUS PERFORMANCE CONT.

• Working Pressure
• Flow Rate
• Test Solution

• 32 PSI
• 8 Litres/min
• Water

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MICRO CIRRUS PERFORMANCE

• Aerosol Output
• Nebulisation Time
• Efficiency
• Respirable Output
• Residual Volume

• 0.12g/min
• 25-30 min
• 96 (0.5-2µ)
• 0.12 g/min
• 1.2 mls

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MICRO CIRRUS PERFORMANCE CONT.

• Working Pressure
• Flow Rate
• Test Solution

• 30-34 PSI
• 8 Litres/min
• Pentamidine

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FEATURES BENEFITS

• Flat base
• Smooth screw top
• 22F connection
• Can operate in the near horizontal position

• Can be placed on a level surface for filling
• Prevents leaks if used in a breathing system
• Fits all aerosol masks
• Ideal for patients who cannot sit upright. Use
  in a breathing system

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FEATURES BENEFITS CONT.

• Anti spill volume of 5mls
• Angled base plate
• Complete systems

• Prevents wastage or swallowing if tilted
• Minimizes residual volume
• Full component range ie, mask, mouthpiece,
• T-Piece, directional valve, filter, oxygen and
  scavenging tubing

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The Cirrus Micro Cirrus Range
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CIRRUS MICRO CIRRUS

• No changes to the product range
• No Sure Loc (in standard products)

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USING A FACEMASK

• Pros
• High patient/clinician compliance
• Cons
• Deposition on face
• Nasal breathing deposition in anterior nares
• Poor mask seal leakage

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USING A MOUTHPIECE

• Pros
• No facial deposition
• No leakage
• No nasal deposition
• Cons
• Tiring for the patient

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USING A T - PIECE

• For adults, children or neonates being ventilated
• Sited between tracheal tube and Y-Piece or
• in the inspiratory limb prior to the Y-Piece

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REASONS FOR POOR NEBULISER PERFORMANCE

• Gas flow rate too low
• Nebuliser not in the upright position

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CIRRUS

• FLOW RATE OUTPUT EFFICIENCY
• 8 l/min 0.31 g/min 76
• 6 l/min 0.20 g/min 50
• 4 l/min 0.12 g/min 25

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Open Vent Nebuliser
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Open Vent Nebuliser - Advantages

• Higher output
• ?
• Shorter nebulisation times
• ?
• Increased patient/nurse compliance

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Open Vent Nebuliser - Advantages (cont.)

• A similar output and nebulisation time (to
  standard nebulisers)
• But at lower gas flow rates
• ?
• 1. Reduced risk of tubing disconnection
• 2. Use cheaper, lower spec.n compressors