Desaturating while giving a Neb Tx. What to do?

There are times when a patient is on a large amount of O2 and a nebulizer tx has to be given, but we know that a standard neb given with only 6-8 lpm is not enough flow or fio2 to keep O2 saturation >= 90% (our current protocol), so what do you do?

Drawing on my personal experience and reading about other RT's idea's and experience here are some ways to help keep the patients saturation at appropriate levels or at least close appropriate.

1. Place a nasal cannula under the aerosol mask or run with a standard HHN.
2. Place 6 inch large bore tubing in the holes in the aerosol mask, looks like elephant tusks.
3. Tee in the nebulizer into a non-rebreather mask. This gives the highest fio2 in my opinion.
4. With a regular HHN instead of using a 6 inch reservoir tube on the end, increase the length of the reservoir tube to 3 lengths of 6 inch tubing or whatever you think will work, this will decrease the amount of room air that patient with entrain.
5. You could always just put the HHN under the Non Rebreather mask but this can also cause comfort issues for the patient in my opinion.
6. If they just need a little extra fio2 you can always use a HHN with nose clips, this way it decreases the amount of inspired Room Air through the nose.
7. Place the HHN in the side port of the aerosol mask and run oxygen from the normal port of the aerosol mask.

Alright there are a few different ways to increase fio2 while running a neb and I'm sure there are many other rigged ways I would like to hear about, but you must also think, is the flow of the extra oxygen going to hinder the deliverance of the medication of the neb or not? I guess if this situation comes up see what works and go for it.

If anyone has any other ideas of ways to complete this task feel free to post a comment or criticism on the ideas I have posted here. Thanks for reading and responding.