I'm curious where most RT's feel the correct placement of a neb is in a vent circuit? I have three scenarios that I see in Florida. All using a valved tee.
1.) Place the neb between the in-line suction device and the HME and don't remove the HME (if using humidifier then between the in-line suction device and the circuit wye.
2.) Place the neb at the wye on the inspiratory side between the insp circuit limb connector and the wye. (By-Pass or remove HME if used).
3.) Place the neb at the beginning of the inspiratory limb (Between vent outlet and insp limb and by-pass the HME) (or with humidifier--between humidifier chamber and insp limb.
There are some other scenarios out there but these are the three most seen. I know what the literature says and what VAP guidelines say. But VAP does not appear to be present in Florida :-)
Anyone having literature to support scenario #1 please let me know how to get a copy?
Thanks!