Aerosol

Generators

INTRODUCTION

An aerosol is defined as a suspension of solid or liquid particles in a gas. Aerosols may be

administered to deliver medication or to deliver a bland solution for the purpose of sputum
induction, treatment of upper airway edema, or humidification of a bypassed or compromised upper
airway. The respiratory care practitioner (RCP) has many devices available to generate aerosols for
application to the upper or lower airway. These devices include small-volume nebulizers (SVNs),
large-volume nebulizers (LVNs), gas injection nebulizers (GINs), nasal atomizers, metered-dose
inhalers (MDIs) and auxiliary spacing devices, dry powder inhalers (DPIs), and ultrasonic nebulizers
(USNs). The selection and use of the most appropriate device is based on the specific clinical
application and the desired therapeutic goals. The RCP should consider several factors in this
selection, including the intended target area of the respiratory tract to be treated; the proven
efficacy of the technique being used; patient preference, coordination, and cooperation; availability
of medications; convenience; and patient tolerance. Before the RCP can apply these devices in the
clinical setting, the RCP must understand the operating principles, advantages, and limitations of
each device.

This activity module focuses on aerosol delivery devices used for continuous aerosol therapy. Also,
emphasizes medication delivery devices and techniques.

OBJECTIVES Upon completion of this module, you will be able to:

1. Differentiate among the types of aerosol generators by operating principle.

2. Given a specific clinical situation, select and apply the appropriate aerosol delivery device.

3. Discuss the limitations of each type of aerosol delivery device.

4. List the hazards and complications associated with aerosol delivery.

5. Practice communication skills needed to explain the application of an aerosol device to a patient
and confirm patient understanding.

6. Practice medical charting for the therapeutic application of an aerosol delivery device.

7. Apply infection control guidelines and standards associated with aerosol delivery equipment and
procedures, according to OSHA regulations and CDC guidelines.

EXERCISE 1 LARGE-VOLUME NEBULIZER (LVN)

 COMPONENTS OF AN LVN
Examine a large-volume nebulizer and use the following list to identify the labeled
components in Figure 1. Record the components in your laboratory report.
DISS connection
Air entrainment ports
Fio2 adjustment (entrainment selector)
Jet
Baffle
 Capillary tube Pressure pop-off (not shown)
Filter
Outlet

Figure 1. Components of a large-volume nebulizer

 ASSEMBLY OF AN LVN
1. Assemble the nebulizer according to the manufacturer’s instructions.
2. Aseptically fill the nebulizer with sterile water. If a prefilled nebulizer is used, be sure not
to contaminate the internal surfaces.
3. Attach the heating element and adjust the settings, if available, to achieve 37°C.
4. Attach the nebulizer to the DISS outlet of a flowmeter.
5. Adjust the Fio2 by turning the entrainment selector to the 100% setting. 6. Turn the flow
to 10 Lpm and observe the mist density and output, the total flow, and the size of the
entrainment port. Record your observations on your laboratory report.
7. Turn the flowmeter to 15 Lpm or as high as it will go. Record the highest flow achievable
on your laboratory report.
8. Return the flow to 10 Lpm.
9. Set the entrainment selector to 35% oxygen. Note any changes in the mist density and
output, the total flow, and the size of the entrainment port. Record your observations on
your laboratory report.
10. Set the entrainment selector in between any two oxygen settings. Record the settings on
your laboratory report.
11. Attach six lengths of corrugated tubing.
12. Place the temperature probe adaptor one tubing length from the patient interface.
Insert the temperature probe. 13. Place another temperature probe adaptor about halfway
between the nebulizer and the patient interface. Insert the temperature probe.
14. Note the time. Record the beginning temperature on both probes on your laboratory
report. 15. Measure the time it takes for the temperature to reach 37°C on each probe.
Record the times and final temperatures on your laboratory report.
16. Analyze the Fio2 and record it on your laboratory report.
 17. Adjust the Fio2 by turning the entrainment selector to 0.40. Analyze the Fio2 and
readjust the entrainment selector if necessary to ensure that the nebulizer is delivering 40%
oxygen.
18. Put water in the corrugated tubing so that the lumen of the tube is occluded in the loop,
or “belly,” of the tubing, as shown in Figure 1.
19. Analyze the Fio2 and record it on your laboratory report.
20. Drain the water from the tubing by “milking” the tubing away from the device and into a
waste receptacle.
21. Attach a water trap by cutting the corrugated tubing in the belly of the tubing and
attaching the trap to the ends of the tubing, as shown in Figure 2.
22. Turn the liter flow to 5 Lpm. Observe the mist output and record your observations on
your laboratory report.

Figure 1. Water in the corrugated tubing.

Figure 2. Insertion of a water trap in a nebulizer setup.

EXERCISE 2 AEROSOL DELIVERY DEVICES

 IDENTIFICATION OF AEROSOL DELIVERY DEVICES
Using the following list, identify the labeled devices shown in Figure 1. Record the devices in
your laboratory report.
Tracheostomy collar (mask)
 Aerosol mask
Face tent
Briggs adaptor (T-piece)

A B C D
Figure 1. Aerosol delivery devices.

Figure 2. Aerosol setup with a face mask. Figure 3. Aerosol setup with a face tent.

Figure 4. Aerosol setup with a tracheostomy collar.

 Figure 5. Aerosol setup with a Briggs adaptor

 APPLICATION OF AN AEROSOL GENERATING DEVICE

Using your laboratory partner as a patient, or a human patient simulator or mannequin, set up and
deliver a heated aerosol at an FIO2 of 0.40 (unless otherwise specified by your instructor) for each of
the following scenarios: a spontaneously breathing patient (Fig. 2); a spontaneously breathing patient
with facial injuries (Fig.3); a tracheostomized patient (Fig. 4); and an intubated patient (Fig. 5).

1. Check the “chart”:

Verify the physician’s order or protocol for mode of delivery and Fio2. Check the
patient’s diagnosis.
2. Gather the necessary equipment: Large-volume nebulizer, prefilled if available Corrugated
tubing Sterile water Heating element Temperature probe and in-line adaptor Oxygen
flowmeter and gas source Water trap or aerosol T-drainage bag Scissors Appropriate aerosol
delivery device (mask, T-piece, tracheostomy collar, or face tent)
3. Wash or sanitize your hands. Apply standard precautions and transmission-based isolation
procedures as appropriate.
4. Introduce yourself and your department. Verify the “patient’s” identification. Explain the
procedure to the “patient” and confirm that the “patient” understands.
5. Assemble the equipment.
6. Adjust the gas source to the appropriate flow rate for adequate flow to meet the
“patient’s” inspiratory demand. In most cases, this is between 8 and 12 Lpm. For oxygen
concentrations of 60% or above, a tandem or double setup or gas injection system should be
used. This is demonstrated in Exercise 4.
REMEMBER: Never place “dead” equipment on a patient!
7. Attach the delivery device to the “patient.” Ensure “patient” comfort.
8. Analyze the Fio2 and adjust the entrainment selector if necessary.
9. Document the procedure appropriately.
“Chart” your therapy on your laboratory report.
 EXERCISE 3 ULTRASONIC NEBULIZER (USN)
 LARGE-VOLUME USN
Using the following list, identify the labeled components of the large-volume ultrasonic
nebulizer shown in Figure 1. Record them on your laboratory report.
On/off switch
Continuous feed inlet
Couplant chamber
Diaphragm Medication chamber
Amplitude adjustor
Blower
Piezoelectric element
 APPLICATION OF THE LARGE-VOLUME USN
1. Fill the couplant chamber with tap water.
2. Aseptically fill the medication chamber with 50 mL of sterile water.
3. Plug the unit into an electrical outlet.
4. Turn the unit on with the amplitude at its lowest setting. Note the time and gradually turn
the amplitude to the maximum setting. Record your observations on your laboratory report.
5. Track the time required for the unit to go dry and record it on your laboratory report.
6. Refi ll the medication chamber.
7. Insert an in-line adaptor to titrate oxygen into the gas flow. Attach one end of a small-
bore oxygen tube to the adaptor and the other end to a flowmeter. Adjust the flow to obtain
an Fio2 of 0.30.
8. Drain the tap water from the couplant chamber. Fill it with sterile distilled water.
9. Reassemble the USN and turn it on.
Record your observations of USN function on your laboratory report.

F
H

Figure 1. Components of an ultrasonic nebulizer.

 MEDICATION SMALL-VOLUME USN
1. Obtain a small-volume medication USN. Identify the brand and model, components, and
controls of your unit and record them on your laboratory report.
2. Insert a disposable diaphragm.
3. Add 1 mL of normal saline solution (NSS) to medication chamber.
4. Turn unit on and note mist density. Adjust if possible.
5. Continue to add NSS to maximum capacity.
Note this amount on your laboratory report.

EXERCISE 3 GAS TITRATION

1. Assemble the gas titration system as shown in Figure 1 with the nebulizer attached to a
compressed gas source.
2. Turn the flow to 10 Lpm.
3. Adjust the oxygen flowmeter to achieve the following values of Fio2: 0.24, 0.30, and 0.45.
4. Record your observations and liter flows required on your laboratory report.

Figure 1. Setup for titrating to a specific FIO2.

 TANDEM NEBULIZER SETUP

1. Assemble two large-volume nebulizers in tandem, as shown in Figure 1.
2. Set the flowmeters on each device to 10 Lpm.
3. Turn the flow rate up to 15 Lpm. Record your observations on your laboratory report.
Return the flow to 10 Lpm.
4. Set the entrainment selector on each nebulizer to the following: 0.50, 0.60, and 0.80.
Observe the mist density and output and the total flow. Record your observations for each
setting on your laboratory
Figure 1: Tandem nebulizer set-up
 F

Laboratory Report
AEROSOL GENERATORS

Name: Roxlai bieber_______________________________

Date: ________________________
Course/Section: _____________
Instructor:______________________________________

DATA COLLECTION
EXERCISE 1: Large-Volume Nebulizer
A. JET
B._ Fio2 adjustment (entrainment selector) baffle
C. DISS CONNECTION
D. AIR ENTERTAINMENT PORTS
E. OUTLET
F. FILTER
G. CAPILLARY TUBE

ASSEMBLY OF AN LVN
Type and brand of nebulizer used: _________________________________________
Entrainment Selector at 100%
Mist density at 100%: __________________________________________
Total flow at 100%: ____________
Entrainment port size: ______________________________
Flowmeter at 15 Lpm: ________________
Entrainment Selector at 35%
Mist density at 35%: __________________________________________
Total flow at 35%: ____________
Entrainment port size: ______________________________
Temperature Probes
FIO2 set between _______________________________ Time: _________
Heating element setting: _____________
Initial temperature of probe nearest humidifier: ___________________
Time to achieve 37°C of probe nearest humidifier: _________________
Final temperature of probe nearest humidifier: ____________________
Analysis of FIO2_____________________________________________
Water in Tubing
Analysis of FIO2:_____________________________
5 Lpm flow:________________________________

EXERCISE 2: AEROSOL DELIVERY DEVICES

IDENTIFICATION OF AEROSOL DELIVERY DEVICES

A. AEROSOL MASK
B. FACE TENTS
C. TRACHEOSTOMY COLLAR
D.BRIGGS ADAPTOR

APPLICATION OF AN AEROSOL GENERATING DEVICE

Chart the procedures for each of the following scenarios.
1. Spontaneously breathing patient______________________________________________
 _____________________________________________________________________
___
_____________________________________________________________________
2. Spontaneously breathing patient with facial injuries: _____________________________
___________________________________________________________________________
___________________________________________________________________________
3. Tracheostomized patient: ____________________________________________
___________________________________________________________________________
___________________________________________________________________________
4. Intubated patient:
___________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

LARGE-VOLUME USN
Continuous feed inlet
Couplant chamber
On/off switch
Amplitude adjustor
Blower
Diaphragm
Medication chamber
Piezoelectric element

APPLICATION OF THE LARGE-VOLUME USN

Amplitude at maximum observations: __________________________________________

Time until unit is dry: __________________
Drained couplant chamber observations: ____________________________________
Couplant filled with sterile water observations: _________________________________

MEDICATION SMALL-VOLUME USN

Brand and model used: _____________________________
Components and controls: _____________________________________
Amount of saline solution added: _____________________________________

EXERCISE 3: Gas Titration

Observations:
___________________________________________________________________________
___________________________________________________________________

Tandem Nebulizer Setup

 Observations of 15 Lpm flow rate: ______________________________________________
Observations of mist density and total flow:
FIO2 = 0.50 ___________________
FIO2 = 0.60 ______________________
FIO2 = 0.80 ______________________

Critical Thinking Questions

1. What was the effect on the Fio2 of water in the corrugated tubing? Why did that
effect occur?

Back pressure will be generated by the water in the tubing, preventing the air from being entrained.
As a result, the total flow would be reduced while the FiO2 generated by the unit would increase. If
the total flow does not meet the inspiratory flow demand, the patient can receive FiO2 as room air is
entrained around the delivery system.

2. What effect did increasing the amplitude of the USN have on the aerosol’s density?
What determines the particle size of the USN?
The density of the mist increased as the amplitude was increased.

The frequency of the piezoelectric factor determines particle size.

3. The physician orders an ultrasonic treatment to be given to a patient who requires
nasal oxygen at 5 Lpm. How would you adapt the equipment?

During the procedure, either titrate the oxygen into the device through a titration
port, titrate in-line, or cover the cannula with the aerosol mask.
4. Under what circumstances would it be necessary to use tandem nebulizers?
When a single unit's flow isn't enough to satisfy the patient's inspiratory flow
demand; otherwise, the required FiO2 can not be provided.
5. What are five factors that should be considered when choosing the proper aerosol
delivery device for a patient?

The medication being administered, the desired deposition location, the patient's
characteristics (age, disease, willingness to obey instructions), the patient's ability to
correctly use the device, and the patient's choice.