What is the recommended protocol for using lidocaine (lidocaine) nebs at home?

Lidocaine Nebulizer Protocol for Home Use

For home use of lidocaine nebulizers, patients should use a jet nebulizer with a drug volume of 2-5 ml, administer treatments for 5-10 minutes until "spluttering" occurs, and clean the equipment daily with warm water and detergent. 1

Equipment Requirements

• Use a jet nebulizer, which is generally most suitable for home administration 1
• Each patient should have their own tubing, nebulizer chamber, and mouthpiece/mask 1
• Nebulizer chambers come in two types:
  • Disposable versions (last up to 3 months)
  • Durable versions (last up to 1 year) 1

Preparation and Administration

• Drug volume should be 2-5 ml 1
• If the nebulizer has a residual volume >1.0 ml, make up the drug volume with 0.9% sodium chloride (not water) to a minimum of 4.0 ml 1
• Put drugs into the nebulizer immediately before use as they no longer contain preservative 1
• Nebulization should take 5-10 minutes 1
• Patient should tap the nebulizer cup towards the end of treatment 1

Administration Technique

• Patient should sit upright or in a chair 1
• Use normal steady breaths (tidal breathing) 1
• Do not talk during nebulization 1
• Keep the nebulizer upright throughout treatment 1
• Continue nebulizing until about a minute after "spluttering" occurs (not until "dryness") 1

Safety Considerations

• Be aware of signs of lidocaine toxicity:
  • Early signs: tingling of tongue/lips, light-headedness, tinnitus, slurred speech 2
  • Progressive signs: muscle twitching, loss of consciousness, respiratory arrest 2
  • Severe toxicity: myocardial depression, cardiac arrhythmias, ventricular arrest 2
• Maximum recommended dose of lidocaine without epinephrine should not exceed 4.5 mg/kg of body weight, with a general recommendation that total dose not exceed 300 mg 3

Cleaning and Maintenance

• Empty the nebulizer after each use 1
• For regular users: clean nebulizer daily 1
• For intermittent users: clean after each use 1
• Cleaning procedure:
  • Disconnect and disassemble nebulizer and mouthpiece/mask 1
  • Wash in warm water with a little detergent 1
  • Allow to dry overnight 1
  • Run the nebulizer for a few seconds with no drugs before next treatment 1
• Replace equipment if there are any scratches, damage, or discoloration 1

Patient Education

• Patients should be taught how to use, clean, and assemble the nebulizer before going home 1
• Written instructions should be provided for reference 1
• Patients should know when to call for help if problems arise 1
• Consider timing of nebulization in relation to meals (nebulizers just before meals may spoil appetite) 1

Follow-up and Monitoring

• Home nebulizer treatment should ideally be run by a centralized local nebulizer service following hospital protocol 1
• Long-term treatment with nebulized drugs should usually be initiated only after assessment by a hospital specialist 1
• General practitioners should only initiate treatment after specific training 1