VentWorld    VentWorld    ventworld.infopop.cc  Hop To Forum Categories  RC Professionals    Mask versus Mouthpiece Nebulizer treatments
Page 1 2 
Go
New
Find
Notify
Tools
Reply
  
Mask versus Mouthpiece Nebulizer treatments
 Login/Join
 
<Rose>
posted
First of all I'm looking for a study on the Internet regarding mask vs. mouthpiece nebs. Which is the preferred, etc. And second I would like opinions on whether mask or mouthpiece is better and why you feel that way.
 
Reply With QuoteReport This Post
Junior Member
posted Hide Post
I think that it's not which is most efficient, but what does the patient need? A patient that is awake and alert and able to hold the neb should be encouraged to do so. If the patient is unable to hold the neb, the next best thing is a mask, which is not as focused as a mouthpiece, but functional. In pediatrics, patients that are too young to hold the neb usually won't tolerate a mask, so we use "blow-by" which is probably the most inefficient method since less aerosol is directed to the patient. Infants get the least because not only do we have to use the "blow-by" method, but they are obligate nose breathers which causes many particles to be filtered out. It's important to be concerned about which is superior, but in the end you do what you have to in order to get the most aerosol into the patients lungs, even if it's not optimal.
 
Posts: 1 | Location: Newark, DE 19713 | Registered: March 21, 2003Reply With QuoteReport This Post
Member
posted Hide Post
I have to agree with Kristin. So many times I see "able-bodied" patients with masks attached to their treatment nebs. When I question them, they say "I like it that way". When I tell them they aren't getting their moneys worth, they agree to change to the mouthpiece. Active participation in their therapy will improve medication deposition. I tell my patients that the medicine "slapping them in the face" with a mask treatment doesn't help. I have yet to get an argument, especially from someone who can't breathe.

On the other hand, the best way to deliver the medication is what works best for the individual. If I suspect (or experience) a patient putting the treatment down when I turn my back, then mask therapy would be the way to go.
 
Posts: 9 | Location: Cleveland, OH, USA | Registered: November 25, 2002Reply With QuoteReport This Post
<WOLF>
posted
I AGREE WITH KRISTIN, THE MOUTHPIECE IS MORE EFFECTIVE WAY TO DELIVER A HHN. TOO MANY TIMES I FIND AN ASTHMATIC PT WITH SEVERE WHEEZING GIVIN A MASK TX. IF THEY CAN HOLD A MP TX I WILL MAKE THEM TAKE A MP TX EVEN IF THEY PREFERR A MASK. AND IF THERE IS A FAMILY MEMBER OR SITTER IN THE ROOM, HAVE THEM HOLD IT FOR THEM AND ENCOURAGE THE PT TO SLOW DEEP BREATH WITH AN OCCASIONAL INSP. HOLD. THIS SEEMS TO HELP THE PT RELIEVE THEIR BRONCH.SPASM MUCH BETTER THAN A MASK. THE STRAIGHT SHOT OF MEDS THROUGH THE MP WILL LOWER THE PRN CALLS YOU WILL RECIEVE FROM THAT PT.m0digity@earthlink.net
 
Reply With QuoteReport This Post
Member
posted Hide Post
One trick I've started utilizing when using an aerosol mask on adults or peds is to put a piece of corrugated tubing (1 segment for adults or adolescents, less for smaller kiddos) in each of the air entrainment holes of the aerosol mask. This creates a resevoir of both oxygen and nebulized medication for the pt to breathe in rather than entraining 90% room air and the other 10% being whatever happens to be in the mask during inspiration. This works particularly well with patients who have an increased O2 requirement. As long as there is adequate flow to the neb there should be no CO2 retention.
 
Posts: 4 | Registered: July 19, 2007Reply With QuoteReport This Post
Member
Picture of light
posted Hide Post
Robert,
this is called a tusk mask. I believe the AARC journal had a write up on this a few years ago. Delivery of a SVN via mask with the SVN running at 8 L/min will produce a FiO2 of ruffly 40-50% (Still dependant on pt's inspiratory flow demands), For every bilateral link of Lg bore tubing you Add you will increase the FiO2 about 10%. We have found in our lab that putting more than three links on each side does not raise it any further, but at this point you are delivery about 70-80% FiO2. Once again all of these FiO2's are dependant on the patients inspiratory flow demands since it is still a low flow device set-up.


Light
 
Posts: 104 | Location: Springfield, MO | Registered: March 08, 2004Reply With QuoteReport This Post
Member
Picture of GJ,RRT
posted Hide Post
How about adding a 1-6Lpm n/c to the "tusk mask", with three links on each side to increase Fio2?

GJ


Chris Hanson RN, RRT-NPS, CPFT, AE-C
ER Registered Nurse
Grand Junction, Colorado
 
Posts: 66 | Location: Grand junction, colorado | Registered: August 21, 2006Reply With QuoteReport This Post
Member
Picture of light
posted Hide Post
Chris,
That would work to increase the FiO2, but would that encourage the patient to breath through their nose instead of their mouth?


Light
 
Posts: 104 | Location: Springfield, MO | Registered: March 08, 2004Reply With QuoteReport This Post
Member
Picture of GJ,RRT
posted Hide Post
I would stress to the patient that by breathing through their mouth they'll get more of the med.
What about adding 3-6 links to the end of a mouthpiece neb treatment with a 1-6Lpm n/c, and stressing tight lips during the treatment. I'm not questioning the tusk mask(great idea), just wanting to know if there's something more effective while giving a high Fio2.

GJ


Chris Hanson RN, RRT-NPS, CPFT, AE-C
ER Registered Nurse
Grand Junction, Colorado
 
Posts: 66 | Location: Grand junction, colorado | Registered: August 21, 2006Reply With QuoteReport This Post
Member
Picture of light
posted Hide Post
As long as the patient is breathing through their mouth, the mask is just effective as the mouthpiece. Or atleast I have not seen anything to disprove this yet. Now as far as the set-up you mentioned, it should work I just have not tested it. Most patients that are needing that high of FiO2 are not going to be able to be that cooperative with a mouthpiece from my experience and I would begin to wonder why I am doing an aerosol to begin with on that patient. Most of the patients I have had on that high of an FiO2 have a large shunt due to atelectasis so I am switching them to IPV instead anyways. Or the patient has a bad pneumonia and either they do not need the treatment or they need IPV/EzPAP/accapella ...... to help mobilize secretions Or BIPAP is needed. Many times, in my institution, SVNs are ordered as the cure all for O2 needs and SOB. When many of these patients with high FiO2 requirements do not need a bronchodilator, but rather IPV, diuretics, antibiotics..... Too many of my friends believe that if someone is short of breath they need a SVN, instead of looking at the physiology behind the SOB.

Sorry got off track on this post.


Light
 
Posts: 104 | Location: Springfield, MO | Registered: March 08, 2004Reply With QuoteReport This Post
  Powered by Social Strata Page 1 2  
 

VentWorld    VentWorld    ventworld.infopop.cc  Hop To Forum Categories  RC Professionals    Mask versus Mouthpiece Nebulizer treatments

© Copyright Equipment Simulations LLC, 2000-10. All rights reserved.