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Wednesday, March 6, 2013

The truth about blowby treatments

Facts show that over 75 percent of the medicine in a normal mouthpiece breathing treatment is wasted, and as much as 99 percent of the medicine in a blowby treatment is wasted.

A blow by is a treatment whereby you blow the mist past the patient's face.  We usually use these for babies because they can't take a mouthpiece and can't stand the mask.  Sometimes we do these for adult patients who are mentally challenged and fight the mask.  So we blow the medicine by their faces.

Studies show this is useless. However, as often is the case in the medical industry, scientific experience does not always correlate with real life experience and observation in the clinical setting.  I think many of us will contend that we have seen blowby therapies work, as least to a certain extent, although never as well as mask or mouthpiece treatments.

Likewise, most RTs will contend that most breathing treatments ordered are not indicated anyway, meaning that it's better to do a blowby in these cases and just get the treatment done, as opposed to fighting with a patient to wear a mask he doesn't want to wear.  And, if putting a mask on them is going to make them cry, then the patient won't be getting any of the medicine anyway.  Studies show that crying causes turbulence that causes the medicine to impact the airway prior to the bronchioles where it's needed. So a crying patient receiving a blowby treatment would be getting even less of the less medicine.

So, I believe it is better for doctors and nurses to continue to be low informed on blow by therapy because it makes our jobs easier. It allows us to make the best decision on a case by case basis, as opposed to having a doctor insist a mask be forced on a kid.  I have experienced this on my own.  There have been a few incidences where I explained studies on blowby therapy to physicians, only for them to insist I give more and more treatments, even when there was no evidence the treatment would do any good.

When I was a new RT I often tried to explain this to nurses and doctors, and all that resulted in was me giving more treatments to the same patient even when they weren't indicated.  So I vowed I would never speak out again. This way, if the treatment is pointless, you do it and get on with your business.  On the other hand, if the child actually would benefit, you find a way to make it work.

Note: Various therapists were interviewed for the above post, and a majority of them have come to the same conclusion.  Most experts do not recommend blowby therapy, although most respiratory therapists I interviewed agree they still do them.  Some noted that blowby therapy works as well as a mask therapy, although studies refute this claim. So the debate will be ongoing, regardless of scientific evidence and point of care observations.

What do you think?


Anonymous said...

You are an idiot, If you beleave what you are doing is wrong then stand up for it.

Rick Frea said...

As noted in the post, the effort was made. It would be simply impossible for one therapist to petition every physician about the truth about blowby therapy. Those in the industry who read peer reviewed articles among the profession know that that members of the American Association of Respiratory Care and others have been petitioning such for change for many years with no avail.

Rick Frea said...

Even various physicians have noted to bem that respiratory therapy is beyond the scope of a physicians knowledge. Many physicians do not know what medicine like Ventolin does, nor when it's indicated. I'm not just saying this, it's been a discussion among the respiratory therapy profession for years.

Rick Frea said...

So there...