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21.4 Ribavirin administration

Essential equipment

  • Aerosol generator
  • Aerosol generator equipment may vary dependent on the make and model. Additional equipment may be required and nurses should check the manufacturer's instructions
  • Compressed air/oxygen source. Use air or oxygen that meets specifications for medical breathing use. (Choice dependent upon patient's condition)
  • Facemasks (FFP2 or FFP3)
  • Gloves, non‐sterile
  • Eye protection – protective goggles
  • Clean plastic apron
  • Sterile disposable gown
  • Extra bed sheets
  • Pharmaceutical/chemotherapy disposal sharps bin
  • Red bag/alginate bag

Medicinal products

  • Ribavirin (Virazole®)

Pre‐procedure

ActionRationale

  1. 1.
    Explain and provide written information about the nebulization procedure.
    To ensure the patient is properly informed about the procedure (DH [28], C; NMC [86], C).
  2. 2.
    Ensure the patient is in a negative‐pressure room.
    To comply with COSHH guidance ([24], C).
  3. 3.
    Ensure the prescription chart is available and the ribavirin has been correctly prescribed and it has been indicated whether oxygen or pressurized air is required for nebulization.
    To comply with medicines management regulations (NMC [85], C).
  4. 4.
    Apply the safety equipment (facemasks, gloves, eye protection and clean apron) as per local Trust guidance and reconstitute the ribavirin inside the room when a course of treatment is required.
    Ribavirin is usually reconstituted in a pharmacy, but due to its short shelf‐life it may need to be made up by nurses.
    To comply with COSHH guidance ([24], C).
  5. 5.
    Prepare the equipment as per the manufacturer's instructions.
    To comply with the manufacturer's instructions for use. C
  6. 6.
    Ask all visitors to leave the room during administration to reduce risk of unnecessary secondary exposure.
    To minimize unnecessary exposure (COSHH [24], C).
  7. 7.
    Ensure the patient can be observed during treatment and has easy access to call for assistance in case of emergency.
    To react quickly to any deterioration in the patient (NPSA [88], C).
  8. 8.
    Instruct and ensure patient understanding in administration procedure of the nebulizer.
    To ensure patient understanding and safety of staff (COSHH [24], C).

Procedure

  1. 9.
    Apply the safety equipment (facemasks, gloves, eye protection and clean apron) as per local Trust guidance.
    To comply with COSHH guidance ([24], C).
  2. 10.
    Prepare the ribavirin.
    To comply with the manufacturer's instructions for use. C
  3. 11.
    Ensure facemask is fully fitted to patient and cover patient with extra bed sheet, to lessen spread of ribavirin particles to the environment. If using a hood or tent, ensure this is correctly set up.
    To comply with COSHH guidance ([24], C). To comply with manufacturer's instructions for use. C
  4. 12.
    Commence ribavirin administration in accordance with the manufacturer's instructions.
    To comply with the manufacturer's instructions for use. C
  5. 13.
    Check the system components as per manufacturer's guidelines as the medicine solution may form crystal deposits on the inner surfaces of the equipment and these can affect the flow.
    To comply with the manufacturer's instructions for use. C

Post‐procedure

  1. 14.
    At the end of the treatment, staff should enter the room to check if the machine was switched off. Staff should immediately leave the room and wait 5–10 minutes before re‐entering to minimize exposure to the medicine's dust particles, which remain in the air following administration.
    To ensure patient and staff safety (NPSA, [88], C).
  2. 15.
    Discard the ribavirin disposables in a pharmaceutical cytotoxic bin.
    To comply with safe management of healthcare waste (DH [32], C).
  3. 16.
    Place the equipment to one side ready for cleaning in the room.
    To prevent bacterial contamination and cross‐contamination (NHS Professionals [84], C)
  4. 17.
    Apply gloves and clean the equipment as recommended by the manufacturer.
    To prevent bacterial contamination and cross‐contamination (NHS Professionals [84], C)
  5. 18.
    Dispose of any remaining ribavirin in accordance with local policy. Manage any spillage/leakage in accordance with the local spillage policy.
    To comply with safe management of healthcare waste (DH [32], C).
  6. 19.
    Dispose of extra linen. The top pillow case must be disposed of in a red linen bag.
    To comply with safe management of healthcare waste (DH [32], C).
  7. 20.
    Clean all surfaces. Bed sides must be cleaned with soap and water after each dose.
    To prevent bacterial contamination and cross‐contamination (NHS Professionals [84], C).
  8. 21.
    Continue to wear full PPE while the room is being damp dusted. Respiratory precautions will continue as this patient will have a confirmed respiratory virus; goggles may be omitted or removed if not required at this point.
    To prevent bacterial contamination and cross‐contamination (NHS Professionals [84], C).
  9. 22.
    Ensure that cleaning staff wait 2 hours before entering the room to clean the floor with soap and water.
    To comply with safe management of healthcare waste (DH [32], C).
  10. 23.
    Dispose of cleaning material according to local waste management rules.
    To comply with safe management of healthcare waste (DH [32], C).
  11. 24.
    Document administration is completed in nursing notes. Sign for administration of the medicine on the prescription chart and the administration record sheet.
    To comply with medicines management regulations (NMC [85], C).
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