Sodium Chloride Nebulizer Therapy Guidelines

Indications and Administration

The recommended dosage for sodium chloride nebulizer therapy is 0.9% sodium chloride solution with a volume of 2-5 ml, which should be made up to a minimum of 4.0 ml when the nebulizer has a residual volume greater than 1.0 ml 1, 2
Most nebulizers work with drug volumes of 2-5 ml 1, 2
If the nebulizer has a residual volume greater than 1.0 ml, the drug volume should be made up with 0.9% sodium chloride (not water) to a minimum of 4.0 ml 1, 2
Nebulization should continue until about a minute after "spluttering" occurs, typically taking 5-10 minutes, rather than using dryness as an endpoint 1, 2
Patients should tap the nebulizer cup towards the end of treatment to maximize medication delivery 1, 2

Jet nebulizers are generally most suitable for sodium chloride administration 1, 2
A gas flow rate of 6-8 L/min is recommended to nebulize particles to 2-5 μm diameter for optimal deposition into small airways 3
The nebulizer system should include an electrical compressor with a standard flow rate of 6-8 L/min or higher flow rate of >8 L/min 1, 2
Appropriate connecting tubing, nebulizer chamber, and mouthpiece or mask are necessary components of the nebulizer system 1, 3

Water should never be used as a diluent for nebulization as it may cause bronchoconstriction 3
In patients with acute severe asthma, oxygen should be used as the driving gas for nebulization due to hypoxia risk 3
In COPD patients, air should be used unless oxygen is specifically prescribed, as there is a risk of carbon dioxide retention in some patients 3

Nebulizers used regularly should be cleaned daily; those used intermittently should be cleaned after each use 1, 2
Disposable components (tubing, nebulizer cup, mask/mouthpiece) should be replaced every three to four months 1, 2
Compressors require annual servicing 1, 2
Bronchodilators such as β-agonists and ipratropium bromide can sometimes be mixed together with saline to make up to 4.5 ml 3

For sputum induction, hypertonic saline (typically 3%) is administered using a nebulizer, with the first sputum sample often discarded as it may not represent the lower respiratory tract 4
Monitoring of oxygen saturation with a transcutaneous oximeter is recommended during sputum induction as unpredictable arterial oxygen desaturation may occur 4

For sputum induction, the American Thoracic Society recommends using hypertonic saline (3%) 20-30 mL with a high-output ultrasonic nebulizer, and monitoring with transcutaneous oximetry during the procedure due to unpredictable oxygen desaturation risk 5
For acute severe asthma, consider combining saline with bronchodilators, such as β-agonists, rather than using saline alone, as recommended by the Thorax society 5

The British Thoracic Society recommends daily cleaning of the nebulizer for regular use, including disassembling, washing in warm water with detergent, rinsing, and drying thoroughly, and running the nebulizer empty briefly before next use to clear moisture 6
For single-use marked equipment, discard after one use, and for single-patient use marked equipment, follow reprocessing guidelines, as recommended by the Thorax society 6

The American Thoracic Society recommends avoiding nebulizers with particle size <1.0 μm MMD for standard therapy, as they may not be effective for small airway deposition 7, 8

Never nebulise water in infants because inhaled water can provoke bronchoconstriction; only sterile 0.9 % sodium chloride solution should be used. 9
For infants, a face mask secured with straps is preferred over a mouthpiece to accommodate limited coordination. 10

Use a jet nebuliser set to a gas flow of 6–8 L/min to generate aerosol particles of 2–5 µm, which optimally deposit in small airways. 9
Load 2.0–4.5 mL of sterile 0.9 % saline into the nebuliser chamber for a typical infant dose. 10
Apply a tight‑fitting face mask to ensure efficient delivery of the aerosol to the infant’s airway. 11
Encourage a breathing pattern of steady normal breaths with occasional deeper breaths, which maximises aerosol uptake in infants. 12

Normal saline nebulisation is appropriate to assist physiotherapy and facilitate mucus clearance in infants. 9
It may be used as a diluent when mixing bronchodilator agents (e.g., β‑agonists) for infant treatment. 10
Consider saline nebulisation when inhaler‑spacer‑mask combinations are ineffective for delivering medication to an infant. 9

After each use, disassemble the nebuliser and wash all reusable parts in warm water with detergent, then rinse and dry completely before the next session. 11

Do not use tap water or distilled water; only sterile 0.9 % sodium chloride is acceptable for nebulisation. 9
Do not use oxygen as the driving gas for routine infant nebulisation unless specifically prescribed; ambient air should be used instead. 10
Ensure the mask fits tightly to the infant’s face to prevent aerosol loss and maintain therapeutic efficacy. 11