Respiratory Management in Spinal Cord Injury

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RESPIRATORY MANAGEMENT IN SPINAL CORD INJURY (SCI), BREATHING AND THE RESPIRATORY SYSTEM IN SCI: TREATMENTS FOR RESPIRATORY TRACT COMPLICATIONS, RESPIRATORY TREATMENTS WITH A NEBULIZER

Rehabilitation Team, Louis Calder Memorial Library of the University of Miami/Jackson Memorial Medical Center, 2009

If respiratory medication needs to be delivered directly to the lungs, this can be accomplished with a nebulizer, if prescribed by your physician. 

Indications for this treatment are:

• Tightness in chest
• Increased or thick secretions
• Pneumonia (congestion) and/or
• Atelectasis

Reasons to avoid the treatment include:

• Increased blood pressure (autonomic hyperreflexia)
• Increased pulse
• History of adverse reaction to the medication.

The following equipment is needed for respiratory treatments with a nebulizer:

• Nebulizer
• Compressor oxygen tank (to drive nebulizer)
• Oxygen tubing
• Respiratory medication
• Normal saline (cc vials)

Following is the procedure for treatments with a nebulizer:

• Remove cup portion of the nebulizer
• Draw up prescribed amount of the mediation in the eye dropper
• Place medication in the medicine cup with 3cc normal saline
• Return cup to the nebulizer
• Place oxygen tubing on the nipple on the nebulizer and attach other end to the compressor or oxygen tank
• Turn on the compressor or tank until mist is seen coming out of the mouthpiece.
• Check pulse
• Place the mouthpiece in your mouth and take slow, deep breaths. If on a ventilator, the nebulizer can be placed in line in the ventilator circuit. To do this, remove the mouthpiece and connect the nebulizer between the dead space tubing and the exhalation valve assembly.
• During the treatment, monitor the pulse. If the pulse increases to more than 20 beats a minute, discontinue the treatment. Otherwise, continue until the medication is used up.
• Following the treatment, use postural drainage, percussion, assisted coughing and/or suctioning, as appropriate. 

Often, the effects of the treatment are most apparent 15-20 minutes later, and you may need assisted coughing or suctioning at that time.