This video clip shows how the nebulised zanamivir is fitted into the ventilator circuit. Date: 5 August 2009, ICU, Pamela Youde Nethersole Eastern Hospital
Note: On 10 Sep 2009, FDA Warned Against Use of Zanamivir With Nebulizer, weblink here.
The following information is for reference only.
It is an overview of the ventilator circuit of a critically ill patient suffering from H1N1 influenza (swine flu) with Siemens Ultrasonic nebuliser fitted into the inspiratory limb of the circuit.
Click Read More for video clips about the setup.

Special features of this circuit:
1.Circuit pressure can be maintained during the whole process.
2. There is no circuit break during the process which helps to decrease risk of VAP
3. Adequate humidification can be achieved
4. Filter at the expiratory end of ventilator helps to protect the environment from virus and zanamivir

Procedures for giving a dose of nebulized zanamivir
1. Set up the circuit as shown.  A heated humidifier is used.  There is no need to disconnect the nebulizer after every single dose.

2. Aspirate the fluid condensed in the nebulizer as shown below.

3. Dissolve 15mg of zanamivir powder in 3ml of sterile normal saline in a sterile bottle.  Aspirate the solution into a syringe.

4.  Inject the solution into the nebulizing chamber.  A 20G IV cannula with one-way stop cork is left in place for repeated administration.

5. Turn off the heated humidifier and start the nebulizer in the ventilator.