Inhaler With Spacer

<< RESPIRATORY


When the MDI is brand new or has not been used for a while, the medication may separate from the other ingredients in the canister and the metering chamber. Shaking the MDI will mix the ingredients in the drug reservoir but may not produce enough turbulence to re-blend the ingredients in the metering chamber. Priming, or releasing one or more sprays into the air, ensures your next dose will contain the labeled amount of medication.


Considerations:

  • Attempt to provide the student with as much privacy as possible, given the urgency of the situation

Supplies:

  • Inhaler
  • Spacer
  • Student’s Individualized Health Plan/Asthma Action Plan and/or healthcare provider’s order

procedure download skill competency

inhaler
Click on photo to access video.

  1. Gather needed supplies and place on clean surface
  2. Position student providing for as much privacy as possible
  3. Wash hands
  4. If student will be administering medication, have student wash hands
  5. Check for authorization forms/record
    1. Medication Administration Form
    2. Medical provider
    3. Parent/guardian
  6. Check for the Five Rights
    1. The right student
    2. The correct time
    3. The medicine container matches authorization forms and medication administration record
    4. The dose on medication container matches authorization form and records
    5. The medication is in the correct route as identified on medication container, authorization forms and medication record
  7. Ensure that the medication has not expired
  8. Make sure the inhaler and spacer are free of foreign objects
  9. Shake the inhaler for 10 seconds to mix the medicine
  10. Remove the cap from the mouthpiece
  11. Prime the inhaler if indicated
    • When the MDI is brand new or has not been used for a while, the medication may separate from the other ingredients in the canister and the metering chamber. Shaking the MDI will mix the ingredients in the drug reservoir but may not produce enough turbulence to re-blend the ingredients in the metering chamber. Priming, or releasing one or more sprays into the air, ensures your next dose will contain the labeled amount of medication
  12. Place the inhaler mouthpiece onto the end of the spacer
  13. Hold the inhaler between your index finger and thumb
  14. Have the student stand up and take a deep breath in, and breathe out
  15. Have the student put the end of the spacer into their mouth, between their teeth and above their tongue
  16. Have the student close their lips around the spacer
  17. Press down on the top of the inhaler once
  18. Instruct the student to breathe in very slowly until they have taken a full breath
  19. If you hear a whistle sound instruct the student to breathe slower—the breath in should take at least 3-5 seconds
  20. Instruct the student to hold their breath for 5 to 10 seconds
  21. Instruct the student to breathe out slowly through their mouth
  22. Wait 1 minute before having the student take a second puff, if ordered
  23. Repeat steps 1 through 6 if taking a second puff
  24. Have student rinse out their mouth out with water and spit
  25. Wash hands
  26. Document medication administration in student’s medication administration log
  27. Follow up, as needed, with parents/guardian and healthcare provider

Cleaning the spacer:

  1. Remove the mouthpiece and the rubber piece that holds the inhaler
  2. Soak the mouthpiece, rubber piece and plastic chamber in a warm water and small amount of dish soap
  3. Rinse with clean water
  4. Shake off excess water and dry on clean surface in a vertical position, with the mouthpiece side up
  5. Do not dry with a cloth or paper towel
  6. Once dry, store in clean container or bag

Cleaning the inhaler:

  1. Remove the canister from the actuator
  2. Run warm water through the top and bottom of plastic actuator (do not boil or place the actuator in the dishwasher)
  3. Shake off the excess water
  4. Allow the actuator to air dry on a clean surface prior to putting canister back in

Resources:

AeroChamber Plus® Flow-Vu® Anti-Static Valved Holding Chamber: Instructions for Use: http://www.aerochambervhc.com/instructions-for-use/

American Lung Association: Tools and Resources

American School Health Association: Asthma Control Webinar

Asthma and Allergy Foundation of America: Success of the Asthma Management and Education Online Program

Asthma and Allergy Foundation of America: Validated Programs for Children, Parents and Caregivers

Children’s Hospital: University of Missouri Health Care School Nurse Online Module

Merck Childhood Asthma Network and The National Association of School Nurses: The Evolving Role of the School Nurse in Treating and Managing Childhood Asthma – At School and Home

National Heart, Lung and Blood Institute: Asthma Basics for Schools

National Heart, Lung and Blood Institute: Management of Asthma Exacerbations: School Treatment Steps to Follow for an Asthma Episode in the School Setting When a Nurse is Not Available

National Heart, Lung and Blood Institute: Management of Asthma Exacerbations: School Treatment Suggested Emergency Nursing Protocol for Students with Asthma Who Don’t Have a Personal Asthma Action Plan

National Heart, Lung and Blood Institute: Asthma Action Plan

Optichamber http://www.healthcare.philips.com/main/homehealth/respiratory_drug_delivery/optihalerdeliverysystem/default.wpd


References:

Allergy and Asthma Network. Metered-Dose Inhalers (MDI). Available at: http://www.allergyasthmanetwork.org/education/asthma/treatment-and-medications/how-use-metered-dose-inhaler-mdi/

American Lung Association. How to Use a Metered-Dose Inhaler. Available at: http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/understand-your-medication.html

Connecticut State Department of Education. Clinical Procedure Guidelines for Connecticut School Nurses. Available at: http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf

Corjulo, M. (2011). Mastering the metered-dose inhaler: an essential step toward improving
asthma control in school. NASN School Nurse, 26, 285.


Acknowledgment of Reviewers:

Rachel Gallagher, RN, MSN, CPNP, NCSN
Director of Health Services
Milwaukee Public Schools

Jill Krueger, RN, BSN
Director/Health Officer
Forest County Health Department


Page last updated: October 1, 2015