Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Holding Chamber

Holding chambers are devices with one-way valves that hold the medication for a few seconds after it has been released from the inhaler.

Proper Use of a Holding Chamber with Mask:

  1. Remove the cap from the mouthpiece and shake the inhaler.
  2. Place the MDI upright in the holding chamber’s back rubber opening.
  3. Place the mask over the child’s nose and mouth to make firm seal. The valve on the mask will move with each breath taken by the child.
  4. Press down on the canister, releasing one puff of medication.
  5. Hold the mask in place until the child has taken six breaths.  If the child is able, slow deep breaths taken through the mouth are most effective.
  6. If a second puff is required, wait 60 seconds and repeat steps 3-5.

Note: The mask may seem scary to a child at first. The child may need reassurance – pretending to use the mask yourself may help to show the child it is safe. If the child cries while receiving the medication, the medication will still be delivered to the lungs as long as the seal on the mask is tight. Around the age of 5, a child should be ready to transition to a holding chamber with mouthpiece when they are able to take a full breath in and hold.

Proper Use of a Holding Chamber:

  1. Remove the cap on the inhaler (MDI) and holding chamber mouthpiece.
  2. Shake the inhaler well immediately before each use. Insert the inhaler (MDI) into the  back rubber opening on the chamber.
  3. Put mouthpiece into mouth.
  4. Depress inhaler (MDI) at beginning of slow deep inhalation. Hold breath as long as possible, up to 10 seconds before breathing out. If this is difficult, an alternative technique is to keep mouth tight on mouthpiece and breathe slowly 2-3 times after  depressing inhaler (MDI).
  5. Administer one puff at a time. Slow down inhalation if "whistling" sound is heard.
  6. Follow instructions supplied with the inhaler (MDI) on amount of time to wait before repeating steps 3 – 6, as prescribed.
  7. Remove the inhaler and replace the protective caps after use.

Care of a Holding Chamber (with/without mask)

Whichever holding chamber is used, it must be cleaned at least once a week with warm soapywater, rinsed with clean water, and air dried in a vertical position.