How to Order Saline Nebulizer
Order 0.9% sodium chloride (normal saline) 2-5 mL via nebulizer, diluted to a minimum of 4 mL total volume if your nebulizer has a residual volume greater than 1 mL, administered with a jet nebulizer at 6-8 L/min flow rate. 1
Prescription Specifications
Solution and Volume
- Prescribe 0.9% sodium chloride solution (normal saline) as the standard concentration 1
- Order 2-5 mL volume per treatment, which accommodates most nebulizer systems 1
- If the nebulizer has residual volume >1 mL, specify dilution with additional 0.9% sodium chloride to reach a minimum 4 mL total volume 1
- Never use water as a diluent - water can cause bronchoconstriction and should be explicitly avoided in your order 1, 2
Equipment Requirements
- Specify a jet nebulizer system (most suitable for saline administration) 1
- Order a compressor with 6-8 L/min flow rate to generate optimal 2-5 μm particle diameter for small airway deposition 1
- Include standard components: electrical compressor, connecting tubing, nebulizer chamber, and mouthpiece or mask 1
Administration Instructions
- Continue nebulization until approximately 1 minute after "spluttering" occurs (typically 5-10 minutes total), rather than waiting until completely dry 1
- Instruct patient to tap the nebulizer cup toward the end of treatment to maximize medication delivery 1
- For bronchodilator combinations, β-agonists and ipratropium can be mixed with saline up to 4.5 mL total volume 1
Special Considerations by Clinical Context
For Acute Severe Asthma
- Use oxygen as the driving gas (not compressed air) due to hypoxia risk 1
- Consider combining with bronchodilators rather than saline alone
For COPD Patients
- Use compressed air as the driving gas unless oxygen is specifically prescribed, as some patients risk CO₂ retention with oxygen 1
For Sputum Induction
- Order hypertonic saline (3%) 20-30 mL using a high-output ultrasonic nebulizer 3
- Specify monitoring with transcutaneous oximetry during procedure due to unpredictable oxygen desaturation risk 3, 1
- Discard the first sputum sample as it doesn't represent lower respiratory tract 3
Maintenance and Safety Instructions
Cleaning Protocol
- Daily cleaning for regular use: disassemble, wash in warm water with detergent, rinse, dry thoroughly 3, 1
- After each use for intermittent use: same cleaning protocol 1
- Run nebulizer empty briefly before next use to clear moisture 3
Equipment Replacement Schedule
- Replace disposable components (tubing, cup, mask/mouthpiece) every 3-4 months 1
- Schedule annual compressor servicing 1
- For single-use marked equipment, discard after one use; for single-patient use marked equipment, follow reprocessing guidelines 3
Common Pitfalls to Avoid
- Do not order water as diluent - this is a common error identified in ~20% of home nebulizer users that can cause bronchoconstriction 2
- Do not specify dryness as endpoint - this leads to excessive treatment time; stop 1 minute after spluttering 1
- Do not use nebulizers with particle size <1.0 μm MMD for standard therapy 3
- Do not forget to specify gas source (oxygen vs. air) based on patient's underlying condition 1