Saline nebulisers for secretion management

Why use a nebuliser?

Some treatments (such as radiotherapy to the head and neck) and medications can change the consistency of your oral secretions. The secretions may become thick and sticky, making them difficult to cough out or swallow. This can cause them to build up in your mouth and throat, causing coughing, gagging, or difficulty eating and drinking. A saline nebuliser can help to thin down the secretions so that they are easier to cough up and swallow, or spit out.

How does it work?

A nebuliser is a device that turns a liquid, such as saline, into a fine mist, which you can breathe in through a face mask. You will be prescribed saline ampoules to use with the nebuliser. For maximum effect, we recommend using the nebuliser regularly.

Benefits

Using a saline nebuliser often helps to thin down thick, sticky secretions so that they are easier to cough up and swallow or spit out.

Risks

• Overuse of your nebuliser may cause excessive, runny secretions. It is important to find a balance of how often to use the nebuliser, and this will be different for every individual. In general, we recommend using your nebuliser as needed up to a maximum of six times per day.
• Occasionally the first one to two uses of a nebuliser can cause feelings of mild breathlessness. We would suggest sitting calmly and breathing naturally in and out while using the nebuliser.
• If you are concerned, or feel that the nebuliser is making your symptoms worse, please stop using it and contact the head and neck team either in clinic or on the contact numbers provided.

Using the machine

You will be given:

• a nebuliser machine with instructions,
• tubing, chamber and mask (single patient use – with either face or trache mask as appropriate),
• sodium chloride 0.9% ampoules (and/or prescription for)

To use the machine:

• Connect one end of the plastic tubing to the port on the machine, and the other end to the port on the bottom of the chamber. Connect the top of the chamber to the plastic mask.
• Unscrew the chamber into two halves, empty 10ml of saline (this may be more than one ampoule, they can come in 2.5, 5, 10, or 20ml) into the bottom half of the chamber, around the central pillar, and screw the top half back on the chamber. Discard any unused saline in the ampoule.
• Plug the power cable in to the side of the machine (visible only with the lid up), and connect to a wall socket. Turn the machine on using the button inside the lid. You should be able to see a fine mist coming through the mask.
• Place the mask on to your face and secure with elastic.
• You should feel moist air coming through the mask. Breathe in and out normally until the saline has all gone from the chamber, or until you feel it is time to stop (usually around 25 minutes).
• When complete, remove the mask, then open the chamber and pour any remaining saline down the sink.
• Reassemble the mask, chamber and tubing and put the machine on for a minute or two to ensure the tubing has fully dried throughout. This will help to reduce the build-up of residue in the tubing.

Cleaning and maintenance

• After each use, it is recommended to take the saline chamber apart into its three component pieces and wash in warm soapy water, rinse with clean cold water, and allow to air dry.
• Do not immerse the tubing in water.
• To clean the mask, wipe with a clean dry cloth.
• The mask, tubing, and chamber should be replaced at least monthly, or sooner if needed.
• The nebuliser machines are serviced regularly. If your machine is not working properly or is labeled as due for a service please contact the Medical Equipment Library on 01223 256187.

If you no longer require your nebuliser machine, please return it to a member of the speech and language therapy or clinical nurse specialist team at your next appointment or to the speech and language therapy department in outpatients, Level 3, Addenbrooke’s Hospital.

Alternatives

Your speech and language therapist will likely discuss other methods of managing your secretions during radiotherapy.

These may include:

• Ensuring you are well hydrated (usually drinking at least 2 litres of non-caffeinated and non-alcoholic fluids per day).
• Drinking carbonated sugar-free water to help cut through sticky secretions.
• Chewing gum or sucking on sugar free sweets to stimulate saliva production.
• Keeping your mouth clean and using your recommended mouthwashes regularly.

Contacts/further information

If you have any questions please speak to your speech and language therapist directly or contact the speech and language therapy department on 01223 216200.