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Pre‐procedural considerations

Patients should be counselled by a trained healthcare professional on the side‐effects and procedure prior to the administration of the drug. The patient should be counselled by the healthcare professional to self‐administer the nebulizer. The healthcare professional should remain outside the room for the duration of the nebulized treatment unless a severe reaction necessitates intervention. The healthcare professional should ensure that exposure is kept to the minimum level possible.
Pentamidine isetionate should be delivered in a negative‐pressure room to reduce the exposure, and no‐one should enter the room during administration unless a medical emergency is indicated.

Equipment

Personal protective equipment (FFP3 facemasks, goggles, gloves and aprons) must be worn by health professionals administering the drug (European Commission [39]).
The equipment required to perform the procedure is a standard nebulizer consisting of a chamber and mask to deliver salbutamol to the patient prior to the pentamidine inhalation. A pentamidine nebulizer kit, which consists of a Filta‐Guard™ with a purple chamber and mouthpiece, is used to administer the pentamidine.

Assessment and recording tools

It is vital that patients are assessed for their suitability to be treated with pentamidine isetionate and that they have a good performance status. This is to ensure that they can be left safely and are able to self‐administer the pentamidine isetionate nebulizer for the 1‐hour administration of the drug in accordance with COSHH guidelines ([24]).
Pentamidine isetionate is known to cause hypotension in some patients (Joint Formulary Committee [62]). A full set of observations should be taken prior to administration and post administration; these should be documented within the nursing notes.

Pharmacological support

It is recommended that pharmacy make up pentamidine isetionate in a controlled environment with extraction facilities (COSHH [24]).
Bronchospasm has been reported to occur following the use of nebulized pentamidine isetionate, particularly in patients who have a history of smoking or asthma. This should be controlled by prior use of bronchodilators (Joint Formulary Committee [62]).

Non‐pharmacological support

An apprehensive patient may experience anxiety during the procedure. Counselling prior to administration should be undertaken by a trained professional to calm patients and provide them with information. The patient should be given the call bell so that they can attract nursing staff attention should they require it. Relatives should be advised not to enter the room during administration. Due to possible complications of administration it is advisable that the patient is accompanied to the hospital and that someone accompanies them home.
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