Using NRB mask for nebs?

[simongretton]

If we need to give a neb via a mask, my service, and several others I know of just removes the reservoir bag from the non-rebreather mask, and then attaches the nebulizer to the bottom of the mask. We have been doing this for decades and it has never been an issue. Recently, someone at our local ER has been raising concern about this, to the point where they have got our medical director to tell us this is an inappropriate way to administer nebulized medications. Does anyone else have experience and or thoughts about this?

 

[RocketMedic]

I really don’t see a difference here, it seems really minor.

 

[DesertMedic66]

My only concern with it would be some NRB masks have one way valves over the exhalation holes so that could prevent the patient from taking in a full breath since there is no reservoir bag.

 

[Carlos Danger]

My only concern with it would be some NRB masks have one way valves over the exhalation holes so that could prevent the patient from taking in a full breath since there is no reservoir bag.

Exactly this ^^

Plus all the albuterol that leaks out the side of the mask with exhalation, instead of being breathed in by the patient.

 

[simongretton]

Thanks for the good comments. Yes it is best to pull the one way valves off even though in my experience simple masks and NRBs have a loose enough fit that a patient can easily inhale around the mask. Anyway, once the valves are gone and the bag removed, it seems we have a simple face mask. It is common practice to give nebulized medications via a simple face mask everywhere I am aware of. When any mask is used without a reservoir bag it typically has holes in it to allow the patient to take a deep breath. Certainly some of the med will escape out of these holes, but it seems to me that this is just the way it is with nebulized meds.

 

[Summit]

There are face masks for neb tx, we use them for continuous neb treatments, but they have open sides. It is typically more comfortable than a mouthpiece neb if your are pouring 15mg into the chamber and want the patient breathing it for an hour plus

 

[NPO]

You can use the NRB mask as long as you remove the flap from the one way valves.

We have specific masks for this, and the only difference in is the absence of those flaps.

 

[Rano Pano]

I understand inventory is different at every agency, but in my current area we have neb face masks prepackaged. When I've seen providers do the method described by the OP I've found the seal between the mask and neb chamber is not a secure as the neb face mask set ups.

 

[VFlutter]

Aside from the practical concerns it is usually best to use a device deisgned and labeled for the task vs a make-shift device that, although might be practically identical, is technically being used improperly. Have your department order the proper nebulizer mask and avoid the issue. Especially if you are using them enough that this has become an issue with the receiving hospital.

Hard sell when you have that status asthmaticus patient that crashes

 

[DrParasite]

Aside from the practical concerns it is usually best to use a device deisgned and labeled for the task vs a make-shift device that, although might be practically identical, is technically being used improperly. Have your department order the proper nebulizer mask and avoid the issue. Especially if you are using them enough that this has become an issue with the receiving hospital.

This.

In a pinch, can you pull the bag off the NRB and hook up a neb? yes, assuming the neb fits perfectly, but that's not always the case.

use the right tool for the right job: if you need to give a new treatment, use a mask designed to do the job.