1. Delivery system for Virazole (Ribravirin)
SPAG
Delivery system for Virazole (Ribravirin)

2. Terms Nebulizer & Drying Chamber Housing
Parts are kept in the second floor equipment room or ask supervisor.

3. Note: Make sure rubber O-ring seals are present on connections
Assemble
Gather clean sanitized parts (prepared by central supply and packaged)
Place silicone rubber straws on metal spindles
Screw nebulizer parts to lid.
Make sure blue rubber jar gasket is in place

4. Insert drying chamber
1. Place Medicine in jar
Snap 2 hoses to appropriate connectors:
drying flow and nebulizer
3. Insert drying chamber
Click to continue

5. Attach fresh blue corrugated tubing & mask (change each treatment)
adjust
1. Attach to 50 PSI Hose
2. Dial in 26 psi on pressure gauge
3. Nebulizer flow meter on 8 l/m (+/- 2)
Click to continue
4. Drying flow meter on 6 l/m (+/- 2)

6. Look for three dime sized spray patterns on the inside of the nebulizer.
If you don’t observe spray, change the silicone straws.
If still no spray, get a fresh set-up.

7. Drug Dosing Conventional Method:
Physician orders 6 grams Virazole (Ribavirin) in 24 hours
Dissolved in 100ml sterile water by pharmacy
Split into 3 doses of 33.3ml each (2 grams each)

8. Delivery Three 33.3 ml doses are given in 24 hours (Q8)
The SPAG delivers an output of ~15ml per hour
33.3 ml should last approximately 2 hours leaving 6 hours off until the next dose.
2 hours

9. New Set-up or Continuing?
If this is a continuing treatment: please note that you may use the same nebulizer for up to 24 hours. (Nebulizer housing is used for several days)
However, get a clean SPAG nebulizer every day at 3:00PM and leave a fresh set-up for night shift.

10. Discontinuance
Any residual should be drawn-up in a syringe a placed in a yellow bag (chemo waste) do not empty out in the sink
If nebulizer is to be re-used, rinse with sterile water…do not rinse with tap water.
Discard corrugated tubing & mask after each use in a yellow bag (chemo waste).

11. Discontinuance continued…
On nebulizer change-out:
Nebulize warm tap water to clear uptakes and jets
Rinse thoroughly with warm water.
Place Nebulizer and drying chamber in a set-up bag (do not place in a red trash bag) and take to central supply for processing.
Wipe down housing with a sani-wipe. Do not take housing or hoses to Central Supply.

12. Central Processing Location
In the hallway toward the E-tower (that looks at the south tower)….just past the equipment (central) north tower elevators is a double door where dirty items can be dropped off.

13. Charting
In Meditech, chart “SPAG Initial” for the first hour of the initial dose given on the first day of the series.
Chart “SPAG subsequent” for every additional hour and for subsequent days.
Document every hour the patient is receiving Virazole (Ribavirin).