Intranasal Medication Administration Using a Squeeze Bottle Atomizer Results in Overdosing if Deployed in Supine Patients.

BACKGROUND: Vasoconstrictors and local anesthetics are commonly administered using a squeeze bottle atomizer to the nasal mucosa to reduce edema, limit bleeding, and provide analgesia. Despite widespread use, there are few clinical guidelines that address technical details related to safe administration. The purpose of this study was to quantify, via simulation, the amount of liquid delivered to the nasal mucosa when patients are in the supine and upright positions and administration parameters that would reliably provide the desired amount of medication per spray. METHODS: A convenience sample of 10 anesthesia residents was studied. Providers were instructed to use a 25-mL dip and tube nasal squeeze bottle to administer the test solution (sterile water) to a mannequin in the upright (90[degrees] elevation) and supine (0[degrees] elevation) position. After mannequin testing, additional testing was completed with the spray bottles at 0[degrees], 15[degrees], 30[degrees], 45[degrees], and 90[degrees] to determine the relationship between the angles of administration and the amount of liquid dispensed. RESULTS: The mean volume delivered per spray was substantially greater when administered in the supine position (0.56 +/- 0.22 mL) compared with the upright position (0.041 +/- 0.02 mL, difference = 0.52 mL, 95% confidence interval [CI], 0.37-0.67 mL, P =45[degrees]; however, we recommend administering the drug with the patient in the sitting position and the bottle at 90[degrees] because only a small change in angle below 45[degrees] will result in a substantial increase in medication delivered. (C) 2016 International Anesthesia Research Society

http://pdfs.journals.lww.com/anesthesia-analgesia/9000/00000/Intranasal_Medication_Administration_Using_a.97806.pdf