Standardised Training for Parents and Carers

Carer Skills Passport

Standardised Training for parents and carers

NebuliserTraining

Jenny Bayliss SpecialistNurse

Nebuliser – what is it?

A nebuliser is a machine that turns a liquid into a vapour or mist that can be inhaled directly into the lungs. Through the nose and mouth or tracheostomy to help breathing and keeping the lungs healthy.The machine come in different styles but do the same thing.

Aims

The Training session in using a nebuliser and this information book aims to help parents and carers

1.To know what a nebuliseris

2.Tounderstandwhy,whenandhowanebuliserisgiven

3.To know how to set up and use a nebulisermachine

4.To knowhowtolookafterandcleananebulisermachine

5.Toknowwhentogethelp

Whydochildrenwithcomplexneeds haverespiratoryproblems?

Childrenwithcomplexphysicalneedsoftenhaverespiratoryproblemsduetobeing Non-mobile

Poor cough and airway clearance Problems with swallowing and aspiration Muscle weakness and scoliosis

All of these mean secretions can settle onto the lungs causing infection and if left untreated can make the child or young person very poorly.

How do I know there's a respiratory problem?

Youwilllearntorecognisewhenthechildoryoungpersonyoucareforisstruggling. There will be indications suchas

Noisy breathing (including wheeze)

Working hard to breath Poor colour

Not maintaining saturations Coughing a lot

Thick,stickysecretionsthataredifficulttosuction Secretionsthatarenolongerwhiteorclear

HaveyouheardofPRN?

A respiratory assessment will be carried out by a physiotherapist and a plan is put in place, such as

Chest physiotherapy to help with secretions

Posturalchangestoseewhichpositionchangesthechildoryoungperson(CYP)willbenefit fromandareabletouse(e.gtummytime,standingframes,variouspositionchangesetc)

Cough assist for those who cannotcoughthemselves.This helps them to coughup

secretions preventing chest infections

Suction can help clear secretions where a CYP cannot do it themselves Nebulisers help loosen secretions so that they can be coughed up and suctioned

PRN is a shortened word for the Latin word "pro re nata", which means "when needed or when required".

A saline nebuliser may be administered as prescribed on a regular basis at certain times to keep secretions loose and easy to cough up (where the CYP has a cough reflex). This is a preventative measure. Saline nebulisers are also usually prescribed "when required" (or PRN) and can be given as extra when secretions become thick, difficult to cough up or suction.

Inachildwithatracheostomyornasopharyngealairwaystickysecretionscanplacethemat risk of a blockedtube.

Saline nebulisers are sometimes given before chest physiotherapy to help loosensecretions sothatthesecanbecoughedup/suctionedoutifneeded.

NebulisersandcircuitsGivingaNebuliser

A nebuliser is a medicine and should be prescribed like any other medicine The medicine needs to be nebulised using air or oxygen

The nebuliser machine generates the air pressure for you automatically.

Oxygen is used if the child or young person cannot maintain their saturation levels but this needs to be prescribed.

0.9% Normal Saline is the most common nebuliser used for loosening secretions

A steroid can be given for an inflamed, wheezy sounding or tight chest to open the airways

ExampleofsetupofantibioticnebuliserSideEffects

Thisisapictureofanebulisersetuptogivetheantibioticcolomycinbyatracheostomy mask.Thereisafilterattachedtofiltertheparticlesoftheantibiotic.

As with all medicines, the child or young person should be monitored for side effects and consider stopping the nebuliser if symptoms indicate. The nebuliser is not expected to cause any side effects in normaluse.

Do not use the nebuliser solution unless the product is clear and the pack intact. Discard any surplus solution after use to prevent contamination, which could cause the child to become unwell.

Patients using nebulisers at home should be aware that if the usual relief reduces or has littleeffect,theyshouldconsulttheirdoctor.Alwaysreportadversereactionstothedoctor andseekmedicaladviceifyouarepractisingoutsideyourlimitations

Always observe the child or young person during the nebuliser to make sure they are settled and are coping. Carry out a respiratory assessment before, during and after.

You may need to stop the nebuliser to suction if they are coughing a lot and the secretions are very loose causing them to be unsettled and /or cyanosed.

Be mindful that excessive suctioning can lead to more secretion production.

If the child or young person is not settled and managing to tolerate the nebuliser in air, oxygen may be given if it is prescribed.

Procedureforgivinganebuliser

Checktheprescribedmedicationwiththeprescriptionsheet.Alwayscheckthemedicineis therightonefortherightchildandthatitiswithintheexpirydatebeforeitisgiven

Thenebulisercomeswith3parts–achamber(orpotoracorn),amouthpiece/ tracheostomy connector or mask andtubing

The chamber comes in 3 parts – the bottom of the chamber has a gas inlet. This is where the tubing is attached and the medicine goes

Themushroomshapedpieceofplasticoverthegasinlet(thatcomesoff),isneededto allowthenebulisertowork

Thetopofthebluechamberscrewsbackontothebottom,amaskoramouthpiecefits here (The mask needs to be the right size for the child or young person. A tracheostomy maskisusedfortracheostomies).Ifonaventilatorthenebulisercanbegiventhroughthe ventilatorcircuit

Procedureforgivinganebulisercontinued

Encouragethechildoryoungperson(ifappropriate)totakedeepbreathswhilstthenebuliserison to help it work to its maximum. Keep the nebuliser chamber upright and you may need to alter its positioneverysooftensothatallthemedicationcanbeused

Make sure the choice of air or oxygen is right. If oxygen is used it must be prescribed. The flow meter should be set to 6-8L or depended on the manufacturers instructions. If using an electronic nebuliser this will create the air for you

?The child or young person should be observed for side effects

?Allow10-15minutestoadministerthenebuliser.Oncethenebuliserhasfinishedyouwillbeabletohearthedifferenceinsound.Themachinecanthenbeswitchedoff

ObservetheeffectofthenebuliserontheCYPanddocument.Theymayneedsuctionoradditional intervention

If ever you have questions or feel out of your depth ask a health care professional. Never practice outside your limitations.