![]() Connect the assembly to the nebuliser machine.Inject the hypertonic saline into the nebuliser cup.Load 20ml of the 3% hypertonic saline solution.Place the nebuliser cup into the nebulising chamber and ensure that the convex base is sitting in the water.Fill the nebuliser chamber with water to between "min fill line" and "max fill line".Before bringing the patient to the area in which the sputum induction is to be performed (see Appendix 1), assemble and check the equipment (see Appendix 2).importance of donning a surgical mask before leaving the room.importance of staying in the room until coughing has stopped.patient should be encouraged to produce a deep cough sputum specimen.patient should sit upright, place the mouthpiece in the patient's mouth, (apply nose clip) and turn nebuliser on.patient should rinse their mouth and gargle with water (to prevent specimen contamination).need for deep inhalation followed by huffing and coughing.need for mouth breathing during the test.how to notify the staff member if assistance is needed and when procedure is completed.The following points should be explained to the patient prior to the procedure: Preparation for the procedure Assess the patientĪssess the patient for the presence of asthma or any of the other conditions listed under Contraindications and Precautions above. This procedure should only be performed by Physiotherapists and Registered Nurses who have been trained and accredited by their health care facility. The breathing circuit used for sputum induction should have a filter on the expiratory side to reduce environmental contamination. ![]() Staff must wear the recommended TB respiratory protection (P2 mask) while in the room and disposable gloves when handling sputum specimen(s) (refer to NSW Health Policy Directive PD2007_036 Infection Control).Staff performing this procedure should have a documented record of their tuberculin skin test (TST) or Interferon gamma release immunoassay (IGRA) status.The ideal is for these rooms to comply with Australian Standard HB260-2003 for respiratory isolation rooms (Type 5 room), however the minimum requirement is a single room with door closed and air exhausted to the outside of the building without recirculation. Induction of sputum should only be conducted in a single room with a ventilation system that allows for the total exhausting of air from the room to the external environment.Patients who are unable to follow instructions.The relative risks and benefits of the procedure should be discussed with the treating medical team and with the patient before proceeding in the presence of these conditions. lung function impairment (FEV1 less than 1.0 Litre). ![]() hypoxia (SaO 2 less than 90% on room air).thoracic, abdominal or cerebral aneurysms.unstable cardiovascular status, (arrhythmias, angina).As the procedure causes severe coughing the procedure should not be performed in patients in whom severe coughing may be harmful.As hypertonic saline causes bronchoconstriction, the procedure should only be performed after pre-medication with salbutamol and under medical supervision in patients with asthma, suspected asthma, or severely impaired lung function (FEV 1It may also be useful in the diagnosis of miliary tuberculosis and tuberculous pleural effusion Contraindications and precautions Sputum induction is used as an aid to the diagnosis of pulmonary tuberculosis (TB) in patients who are unable to spontaneously expectorate adequate sputum specimens. Strict airborne respiratory precautions should be observed whenever sputum induction is performed. The procedure produces coughing so it is likely that infectious droplets, if present, will be expelled into the room air. Sputum induction is simple and non-invasive, and if successful, often precludes the need for bronchoscopy. The patient inhales nebulised hypertonic saline solution, which liquefies airway secretions, promotes coughing and allows expectoration of respiratory secretions. Sputum induction is a procedure used for patients who have trouble producing sputum spontaneously. ![]() This guideline is to be read in conjunction with NSW Health policy directives PD2017_013 Infection Prevention and Control Policy and PD2018_009 Occupational Assessment, Screening and Vaccination Against Specified Infectious Diseases. ![]()
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