Start by cleaning your hands with soap and water or alcohol-based hand gel. Put on non-sterile gloves. Clean your work surface with soap and water or a disinfecting wipe. Gather the supplies you need: a nebulizer machine, also called a neb machine; neb tubing; a neb cup; the nebulized medicine ordered by the doctor; and a delivery device such as a mouthpiece, face mask, trach mask, or tee adapter. Put the neb machine on a hard, flat surface and plug it into an electrical outlet. Connect one end of the neb tubing to the air outlet port on the neb machine. Attach the other end of the neb tubing to the air inlet port on the neb cup. Remove the cover from the neb cup. If the cup has an insert, be sure it’s in place. Pour the ordered amount of medicine into the cup, then reattach the cover. Connect the delivery device to the neb outlet port on the neb cup. This could be a mouthpiece, facemask, trach mask, or tee adapter. Turn on the neb machine. You should see a fine mist coming from the delivery device. If there is mist coming from the delivery device, place the device on the patient and begin the neb treatment. If the patient has a trach, place a trach mask over the trach or connect a tee adapter to the ventilator tubing circuit to deliver the treatment. Always keep the neb cup as upright as possible during the neb treatment. Gently tap the cup every two to three minutes during the treatment to move droplets of medicine to the bottom of the cup. This ensures the patient receives all the medicine. If possible, the patient should sit upright and breathe normally during the treatment. While it’s not required, taking a big breath and holding it for a few seconds can improve delivery of the medicine into the lungs. The neb treatment is finished when no more mist comes out of the delivery device, even after tapping on the neb cup. There may still be some drops of medicine in the bottom of the cup. Remove the delivery device and neb cup from the patient or a ventilator tubing circuit. Turn the neb machine off and disconnect the tubing from the neb cup. Follow the patient’s care plan when cleaning neb supplies. A common recommendation is to wash the neb cup and delivery device after every treatment. Use warm soapy water and rinse thoroughly. Allow the supplies to air dry before storing them in a clean dry container. Wipe the neb machine, power supply cable, and neb tubing with a cleaning cloth or disinfecting wipe as needed. Do not put these items into water or a cleaning solution. Replace the neb tubing if it is cracked or as often as the patient’s care plan indicates. Follow these troubleshooting tips if there is no mist from the delivery device at the beginning of a neb treatment. First, check for airflow from the neb machine. Disconnect the neb tubing and put your finger over the air outlet port on the machine to block airflow. Remove your finger and listen and feel for a burst of air. If there is not a burst of air, check the filter on the neb machine and make sure it is clean. Follow the manufacturer’s instructions for cleaning or replacing the filter. Then, check for airflow from the machine again. If there is still NO burst of air from the air outlet port, contact the medical equipment supplier. If there IS a burst of air after checking the machine and filter, attach the neb tubing to the neb machine. Put your finger over the open end of the neb tubing. Remove your finger and listen and feel for a burst of air. If you do not hear or feel a burst of air, replace the neb tubing. Check to make sure the neb cup is properly assembled. Attach the neb cup to the neb tubing. If there is still no mist, attach a new neb cup. If this does not solve the problem, contact the medical equipment supplier for further instruction. Put any neb supplies that do not work or are damaged into the trash.