1. Patient Assessment
- Conduct a respiratory history review (asthma, smoking) and assess baseline pulse, respiratory rate, and effort [1][3].
- Pediatric patients require evaluation for age-appropriate cooperation [1].
2. Room Setup
- Use a negative-pressure room or HEPA-filtered containment booth; if unavailable, employ a portable HEPA filter [1][3].
- Run the HEPA filter 1 hour pre-treatment and keep the door closed [1].
3. Medication Preparation
- Reconstitute 300 mg pentamidine isethionate with 6 mL sterile water (not saline) to avoid precipitation [4][2].
- Administer the entire reconstituted solution via a Respirgard II Nebulizer [4][1].
4. Pre-Treatment Medications
- Administer a bronchodilator (e.g., albuterol) 5–10 minutes prior to reduce bronchospasm risk, especially for smokers or asthma patients [2][3].
5. PPE for Healthcare Workers
- Wear N95 respirator (fit-tested), nitrile gloves, chemo gown, and indirect-vented goggles [1][3].
6. Patient Instructions
- Use mouthpiece with nose clips (or mask for young children) and breathe only through the mouth [3][1].
- Monitor for cough, bronchospasm, or fatigue during treatment; allow rest breaks if needed [3][5].
7. Post-Treatment Protocol
- Keep the room closed for 30 minutes post-administration [1].
- Dispose of nebulizers in hazardous waste bags [3].
Note: First doses should ideally be administered in specialized centers for monitoring [1]. Pregnant staff or bystanders should avoid exposure [2].
Citations:
[1] https://www.pogo.ca/satellite-manual/4-0-supportive-care-practice-tools/4-2-pentamidine-administration/4-2-1-inhaled-pentamidine/
[2] https://www.medicines.org.uk/emc/files/pil.14868.pdf
[3] https://www.utmb.edu/policies_and_procedures/4230115
[4] https://www.drugs.com/pro/pentamidine-inhalation.html
[5] https://medlineplus.gov/druginfo/meds/a601208.html
[6] https://www.mayoclinic.org/drugs-supplements/pentamidine-inhalation-route/description/drg-20065369
[7] https://my.clevelandclinic.org/health/drugs/19920-pentamidine-inhalation
[8] https://www.webmd.com/drugs/2/drug-18174/pentamidine-inhalation/details
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