Lab 9
❖ Pressurized Metered Dose Inhaler
1. 1.Warm the MDI to hand or body temperature and shake it for 8-10 seconds.
2. Before first use of a new MDI and when theMDI has not been used for several days, prime the MDI
by pointing it into the air (away from people) and actuating a couple of times.
3. Assemble the MDI and uncap the mouthpiece, ensuring there are no loose objects in the device.
4. Open-mouth technique: Open your mouth wide, keeping tongue down. Hold the pMDI with the
canister oriented downward and the outlet aimed at your mouth. Position the pMDI approximately
4 cm (two fingerbreadths) away from your mouth.
5. Closed-mouth technique: Place mouthpiece between lips. The most Common use technique.
6. 6.Breathe in- out normally
7. As you slowly begin to breathe in (<0.5 L/s), actuate the pMDI.
8. Actuation during a slow (30 L/min or 3-5 seconds) deep inhalation
9. 9.Hold breath as long as possible up 10 seconds, breathe out normally
10. Wait 1 min between puffs.
11. Disassemble the Device (MDI) , and recap the mouthpiece.
• Note : Some of these inhaled medications (like Corticosteroids) can be irritating to the mouth
and Can cause thrush.
• Determining Dose Left in Pressurized Metered Dose Inhaler
Tracking the number of actuations (puffs) remaining in a pMDI can be done with or without dose
counters (see Fig. 40.7).
• With Dose Counters The user should:
1. Determine how many puffs of drug the pMDI has when full.
2. Learn to read the counter display, because each dose counter has a different way of displaying
doses left in the canister.
3. Check the counter display to track the pMDI actuations remaining in the canister.
4. Reorder the pMDI when there are a few days of drug remaining.
5. Dispose of the pMDI properly, after the last dose is dispensed.
• Without Dose Counters The user should:
1. Read the label to determine how many puffs of drug the pMDI has when full.
2. Calculate how long the pMDI will last by dividing the total number of puffs in the pMDI by the
total puffs used per day. If the pMDI is used more often than planned, it will run out sooner.
3. Identify the date that the medication will run out, and mark it on the canister or on a calendar.
4. For drugs that are prescribed to be taken as needed, track the number of puffs of drug
administered on a daily log sheet and subtract them from the remaining puffs to determine the
amount of medication left in the pMDI.
5. Keep the daily log sheet in a convenient place, such as taped to the bathroom mirror.
6. Refill the pMDI prescription when there are a few days of use remaining in the pMDI.
7. Dispose of the pMDI properly when the last dose is dispensed.
• Technique for Use of a Metered Dose Inhaler With Spacers and Valved Holding Chambers
(VHC)
1. Warm the pMDI to hand or body temperature.
2. Assemble the apparatus, ensuring there are no objects or coins in the chamber that could be
aspirated or obstruct outflow.
3. Hold the canister vertically and shake it vigorously. Prime if necessary.
4. Place the pMDI in the holding chamber inlet, position chamber outlet in the mouth (or place the
mask over nose and mouth), and encourage the patient to breathe through the mouth. Visually
inspect for proper valve function.
5. With normal breathing, actuate the pMDI once and have the patient breathe through the device for
three to seven breaths (three breaths for adults and seven breaths for infants).
6. Allow 30 to 60 s between actuations.
How to use MDI : https://youtu.be/gFGM-8X98zs?si=VbbLliUxeAlGyBB9
How use MDI with Spacers and VHC : https://youtu.be/cjyf7lWnEBI?si=7xUasNqSNxLRIR5j
❖ Dry Powder Inhaler
✓ Take a deep breath and hold it. Close the mouth and lips on the Device well.
✓ Take a deep breath while using the Device.
✓ Remove the device from the mouth, then Close the mouth and hold the breath for 10 seconds.
✓ Turn off the device and gargle well with Water after each dose.
✓ New Dry Powder Inhaler Technologies
Easyhaler : https://youtu.be/wdkmQnxsFKU?si=vlgSfxaD2bx92QIz
Ellipta : https://youtu.be/t_vTBm3pVPY?si=MEErg0C5XgBb7Ynm
Podhaler :https://youtu.be/aJ5_dGX5yso?si=FdO9hELcDNsEu6GM
Tudorza pressiar :https://youtu.be/xTKSx_tI10k?si=_57lI5hBZS-K3evi
Spiromax :https://youtu.be/Jik_-lhXgkQ?si=ZUV-7OU8kS4afnFX
HandiHaler :https://youtu.be/cjMLvFFHkiw?si=iuGbYKVMAJ16hBpF
Diskhaler:https://youtu.be/wak2lw_4GjM?si=Zh9sC1uteb_zSnFx
Diskus: https://youtu.be/mfiShjE9P-Q?feature=shared
Flexhaler :https://youtu.be/cUxqHPGEq60?feature=shared
Twisthaler :https://youtu.be/Vsiz8GnSmiM?si=_DULoyltS0WI6zCL
❖ Technique for Using a Small Volume Nebulizer
1. Assess the patient for need (clinical signs and symptoms, breath sounds..).
2. Select mask or mouthpiece delivery (nose clips may be needed with mouthpiece).
3. Use conserving system (thumb port, breath actuator, or reservoir) if indicated.
4. Place drug in the nebulizer. If using a multidose vial, add saline to approved dose volume (per
drug label).
5. Set gas flow to nebulizer at 6 to 10 L/min (per manufacturer label).
6. Coach patient to breathe slowly through the mouth .
7. Continue treatment until nebulizer begins to sputter.
8. Rinse the nebulizer with sterile water and air dry, or discard, between treatments.
9. Monitor patient for adverse response.
10. Assess outcome .
https://youtu.be/V44OI-FjBCk?si=9fArUNz3_roOuyCE
