Chest
Volume 101, Issue 2, February 1992, Pages 316-319
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Clinical Investigations
Disposable Jet Nebulizers: How Reliable Are They?

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We studied the frequency of malfunction, variability in rate of nebulization, and effect of this variability on aerosol particle size of eight disposable jet nebulizer models produced by six manufacturers. Four of eight models showed visual signs of malfunction, including spraying of large, individually visible droplets, leaking of nebulizer solution, and air leaks that completely prevented nebulization. Variability of nebulization rate within specific models ranged from 57 to 129 percent. The model with the largest variability of nebulization rate was also associated with an unacceptably large variability in particle size. In contrast, two models with smaller variability in nebulization rate had greater consistency of particle size. These results indicate poor quality control by some manufacturers in the disposable nebulizer industry. The data suggest that purchasing agents should consider reliability as well as cost before selecting a specific nebulizer model and that their evaluation should include physical testing of multiple units of each model under consideration.

Section snippets

METHODS

In the first phase, we evaluated 12 units of each of the jet nebulizer models for visual signs of malfunction and for rate of nebulization (Table 1). After placing 3 ml of normal saline solution in each nebulizer, we weighed the nebulizer, and air flow through the nebulizer was set at a constant rate of 6 L/min. Every minute for the first 3 min of each trial, the nebulizer was weighed. Nebulization rates (expressed in milliliters per minute) were calculated from weight differences. Nebulization

RESULTS

In phase 1, four of the eight models tested showed visual signs of malfunction (Table 1). Model 8 had large, individually visible droplets spraying out the top of each of five units tested. Model 7 had air bubbling through the saline solution rather than being forced through the jet, such that nebulization did not occur at all in seven of the 11 nebulizers. Model 6 had saline solution leaking from a screw top joint in each of 12 units tested. Finally, model 4 functioned adequately if held at

DISCUSSION

These results indicate a deficiency of quality control or design on the part of some manufacturers in the disposable nebulizer industry. Half of the models tested showed such serious visual signs of malfunction that the rate of clinically useful aerosol output could not be determined. For the model with the largest unit-to-unit variability in rate of nebulization, particle size varied over a wide range and appeared to correlate with rate of nebulization. Unit-to-unit variability in this model

APPENDIX

Empty CellNebulizer Models Investigated*Empty Cell
Designation in ArticleManufacturerModel No.
1Baxter, Valencia, CA00214
2Puritan-Bennett, Overland Park, KS001140 (Raindrop)
3Intec Medical, Bluesprings, MO2016
4Intec Medical, Bluesprings, MO3017
5Hospitak, Lindenhurst, NYUp-Mist
6Hudson, Temecula, CAUp-Draft II
7Baxter, Valencia, CA008120
8AVA Corporation AVA-neb
*

Nebulizer units tested at the time experimental work in this study was performed may or may not be representative of those produced under current practices. We

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