Mucomix (Acetylcysteine) Nebulization Protocol
For adults with excessive bronchial secretions, nebulize 3-5 mL of 20% acetylcysteine solution (or 6-10 mL of 10% solution) three to four times daily via mouthpiece, with each treatment lasting approximately 10 minutes. 1
Dosing and Dilution
- Standard dose: 3-5 mL of 20% solution OR 6-10 mL of 10% solution, administered 3-4 times daily 1
- Dose range: 1-10 mL of 20% solution (or 2-20 mL of 10% solution) every 2-6 hours is acceptable, though the standard dose above is recommended for most patients 1
- Dilution: The 20% solution may be diluted with preservative-free normal saline (0.9% sodium chloride), Sterile Water for Injection, or Sterile Water for Inhalation; the 10% solution may be used undiluted 1
- Critical warning: Never use plain water as diluent—only 0.9% sodium chloride should be used, as water may cause bronchoconstriction when nebulized 2, 3
Administration Method
- Delivery device: Use mouthpiece rather than face mask for mucolytic therapy 2
- Nebulizer type: Standard jet nebulizer with air compressor providing 6-8 L/min flow rate 2, 3
- Treatment duration: Approximately 10 minutes per session 2, 3
- Gas source: Use compressed air or air compressor; avoid routine oxygen unless specifically prescribed for hypoxemia 2
Equipment and Technique
- Nebulizer materials: Use only glass, plastic, aluminum, anodized aluminum, chromed metal, tantalum, sterling silver, or stainless steel components—avoid iron, copper, and rubber which react with acetylcysteine 1
- Patient position: Sit upright, breathe normally (tidal breathing), keep nebulizer upright, and avoid talking during treatment 2
- Tapping technique: Tap the nebulizer chamber when solution begins to "splutter" to increase drug output 2
Bronchospasm Prevention
- Pre-treatment bronchodilator: Administer a β-agonist (such as salbutamol/albuterol) by inhaler or nebulizer before acetylcysteine, as acetylcysteine can induce bronchospasm, particularly in asthmatic patients 4
- Combination therapy: Acetylcysteine can be mixed with bronchodilators (β-agonists, ipratropium) in the same nebulizer chamber if needed 3
Post-Treatment Care
- Mouth rinsing: Rinse mouth after nebulization to prevent oral thrush 2
- Expectoration: Encourage coughing and expectoration during and after treatment, as acetylcysteine reduces sputum viscosity and facilitates clearance 5
Equipment Maintenance
- Daily cleaning: Disassemble nebulizer, wash in warm water with detergent after each use, rinse thoroughly, and dry completely before next use 2, 1
- Storage of opened vials: If only partial vial used, refrigerate remainder and use within 96 hours 1
- Equipment replacement: Change standard jet nebulizers, tubing, and mouthpieces every three months 2
- Antimicrobial precaution: Acetylcysteine contains no preservatives—minimize contamination of the sterile solution 1
Monitoring Parameters
- Clinical response: Assess ease of expectoration, sputum volume and character, and respiratory effort 5
- Oxygenation: Monitor oxygen saturation, as effective mucolysis improves oxygenation 5
- Adverse effects: Watch for nausea, vomiting, bronchospasm, and (if combined with bronchodilators) tachyarrhythmia or agitation 6, 7
Special Considerations
- Timing: Administer before physiotherapy sessions to mobilize secretions more effectively 2
- On-demand vs routine: Recent evidence suggests on-demand use (based on clinical need) may be preferable to routine scheduled dosing, particularly in mechanically ventilated patients, as it reduces adverse events without compromising efficacy 7
- Post-thoracotomy: Acetylcysteine is particularly effective following thoracic surgery for retained secretions, significantly reducing sputum viscosity and improving oxygenation compared to normal saline 5