Nebulizer

<< RESPIRATORY

Considerations:

  • Attempt to provide the student with as much privacy as possible, given the urgency of the situation
  • If appropriate, encourage parents to discuss with their physician the possibility of prescribing an inhaler with a valve holding chamber in place of the nebulizer since research shows that a properly used inhaler with valve holding chamber is as effective as a nebulized albuterol.
  • Nebulizer should be administered in a separate room away from other people, if possible.
  • The school nurse should develop a plan to systematically check the expiration date on the medication to ensure the medication has not expired.

Supplies:

  • Medication
  • Nebulizer machine (air compressor)
  • Connecting tubing
  • Facemask, or a mouthpiece held in the mouth
  • Individualized Health Plan (IHP)
  • Asthma Action Plan or Healthcare provider’s orders
  • Parent/Guardian authorization form
Procedure Download
Skill Competency Download

Procedure:

  1. Position student
  2. Use a room separate from where other students are receiving care (if possible) or one that has limited other use
  3. Explain the procedure to the student at his/her level of understanding
  4. Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
  5. Review Asthma Action Plan or healthcare provider’s orders
  6. Ensure proper documentation of parent/guardian to administer medication
  7. Review the six rights of medication administration to be sure it is:
    • For the right student
    • The right medication
    • The right dose
    • Being given at the right time
    • Being given by the right route
    • Being given for the right reason
  8. Ensure the medication has not expired
  9. Review student’s allergy status
  10. Wash hands
  11. Set up and plug in the nebulizer machine in a location where the power source is close to a comfortable location for the medication to be administered
  12. Follow the directions for the specific brand of nebulizer machine and cup
  13. Review the six rights of medication administration again to be sure that it is:
    • For the right student
    • The right medication
    • The right dose
    • Being given at the right time
    • Being given by the right route
    • Being given for the right reason
  14. Unscrew top of nebulizer cup
  15. Add medication into the bottom half of the nebulizer cup
  16. Screw the top of the cup back on
  17. Attach the tubing from the cup to the nebulizer machine
  18. Attach the nebulizer cup onto the face mask or mouthpiece
  19. Place either the facemask on the student or the mouthpiece in his or her mouth
  20. Turn on the machine
    • A mist of medication should rapidly appear
  21. Instruct the student to take relatively normal slow deep breaths
  22. Keep the nebulizer cup in an upright position
  23. The cup may require some tapping on the sides toward the end of the treatment to optimize the completion of the dose
  24. The treatment is complete when there is no more mist from the cup (usually 10–15 minutes)
  25. Turn off the machine
  26. Remove the mask or mouthpiece
  27. Rinse nebulizer cup, mouthpiece  or mask under warm water
  28. Shake off excess water
  29. Place on paper towel to dry
  30. Monitor student’s heart rate and respirations
  31. Document medication administration in the student’s healthcare record
  32. Wash hands
  33. Have the student rinse out their mouth with water and spit
  34. Have the student wash their hands
  35. Document the intervention and outcome in the student’s healthcare record
  36. Update parents/guardian and healthcare provider, if needed

Cleaning and storing:

  1. Take the nebulizer apart
  2. Set tubing aside
  3. Do not soak, wash or rinse tubing
    • Replace it if it becomes cloudy, discolored or wet inside
  4. Wash the medicine cup and mask with warm, soapy water
  5. Rinse the medicine cup and mask in warm water
  6. Let all pieces air dry on a paper towel
  7. When dry, put pieces in a plastic bag or container

Disinfect weekly

  1. Soak medicine cup and mask in half strength vinegar for at least (1 part distilled white vinegar, 3 parts warm water soluction) for 30-60 minutes
  2. Rinse with water
  3. Let all pieces air dry on a paper towel
  4. When dry, put pieces in a plastic bag or container

Care of the machine

  1. Wipe with a damp cloth
  2. Check the filter monthly
    • Change it every six months or sooner if discolored
  3. The machine should be serviced every five years

References:

American Lung Association. (2023, March 27). How to use a nebulizer. . Retrieved May 24, 2023, from  https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/resource-library/how-to-use-a-nebulizer

American Lung Association. (n.d.). The abc’s of using a nebulizer. Retrieved May 24, 2023, from  https://www.lung.org/getmedia/3124fe1d-abc5-4741-8c17-bc8a449ea67b/ABCs-Nebulizer-V2-4-6-2020_new-branding.pdf?ext=.pdf

Asthma and Allergy Foundation. (n.d.). Quick asthma card. Nebulizers – Medicine in a mist. Retrieved August 4, 2023, from https://www.aafa.org/wp-content/uploads/2022/10/quick-asthma-nebulizers-card.pdf

Lynn, P. (2019). Administering medication via small-volume nebulizer In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 122-124).

Medline Plus. (2022, December 9). How to use a nebulizer. Retrieved May 24, 2023, from https://medlineplus.gov/ency/patientinstructions/000006.htm

Missouri Department of Health and Senior Services. (2022, October 17). Nebulizer guidance for school nurses. Retrieved May 24, 2023, from https://health.mo.gov/living/healthcondiseases/chronic/asthma/pdf/neb-guidance-20221017.pdf

National Heart, Lung, and Blood Institute. (2021, October). How to use a nebulizer. Retrieved May 24, 2023, from https://www.nhlbi.nih.gov/resources/how-use-nebulizer

Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Nonparenteral medications. In Clinical nursing skills and techniques. (10th ed.). (pp. 642-645). St. Louis, MO: Elsevier.

Page last updated: February 28, 2025
Page last reviewed: February 28, 2025

The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same.  The information is not intended to substitute for, supplement or replace clinical judgment.  If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider.  The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.