Salbutamol - Intravenous

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.

Aim

To guide staff with the use of intravenous salbutamol.

Note: Intravenous salbutamol should only be used in discussion with clinicians who are familiar with its use and who have an understanding of doses, concomitant inhaled medications and required monitoring.

Medication

  • Salbutamol is a β agonist that can be used intravenously in severe acute asthma in the Emergency Department
  • It is used as an intravenous infusion (usually in a Paediatric Critical Care (PCC) Unit).

Actions

  • Salbutamol acts on the β2 adrenoceptors in the smooth muscle of the bronchi causing bronchodilation.1

Indications

  • Acute severe asthma
  • Inadequate response to continuous nebulised salbutamol

Contraindications

  • Patients with known hypersensitivity to salbutamol

Precautions

  • Hypertension
  • Hyperthyroidism
  • Cardiovascular disease, susceptibility to QT prolongation
  • Hypokalaemia
  • Diabetes
  • Glaucoma
  • Seizure disorders

Adverse effects

  • Muscle tremors, especially of the hands
  • Tachycardia
  • Nausea and vomiting
  • Headaches, agitation and hyperactivity
  • Palpitations
  • Feelings of warmth
  • High doses can cause peripheral vasodilatation resulting in hypotension
  • Overdose can result in chest pain, SVT and pulmonary hypertension
  • Hypokalaemia
  • metabolic acidosis
  • Hyperglycaemia

Dosage

Continuous Intravenous Infusion:

  • 1 to 5 micrograms/kg/min (start at 1 microgram/kg/min up to a maximum of 80 microgram/min2,3). Discuss with Paediatric Critical Care if considering a higher dose.
  • Infusion rate will be adjusted according to patient response. 

Preparation

Continuous Infusion

  • Drug: 3mg/kg Salbutamol
  • Diluent: 500mL bag of 0.9% Saline or 5% Dextrose
  • Rate of 10mL/hour = 1 microgram/kg/minute2
  • Titrate infusion 1 - 5 micrograms/kg/min according to patient response2,3

Administration

  • Ideally concentrations greater than 200 microgram/mL should be infused via a central line but should not delay initial treatment in an emergency situation4
  • Administer infusion via a syringe pump.
  • Set volume to be infused on the syringe pump to prevent overdose.
  • Always prime the line with the diluted salbutamol solution to prevent any delay in the patient receiving the medication.
  • Note: There is little evidence on the concomitant use of inhaled salbutamol while patients are on an intravenous salbutamol infusion. Its use should be limited to the child who has severe/ life threatening asthma and in consultation with the on-call PCC Consultant.

Nurse special

  • The patient will require 1:1 nursing care
  • Administer IV infusion via infusion pump
  • Continuous cardiac monitoring
  • 5 minutely observations for the first 10 minutes – heart rate, respiratory rate, blood pressure, oxygen saturations. 
  • 15 minutely observations thereafter
  • Electrolyte monitoring at baseline, after 2 hours and then a minimum of 12 hourly1
  • Paediatric Critical Care review of all patients requiring IV salbutamol
  • Consider placing a second intravenous cannula (for further treatment as salbutamol is incompatible with many other drugs).

Bibliography

  1. Starkey ES, Mulla H, Sammons HM, et al. Intravenous salbutamol for childhood asthma: evidence-based medicine? Archives of Disease in Childhood 2014; 99:873-877.
  2. National Asthma Council Australia. Australian Asthma Handbook, Version 1.3. National Asthma Council Australia, Melbourne, 2017. Website. Available from: http://www.asthmahandbook.org.au
  3. Australian Medicines Handbook, Pharmaceutical Society of Australia, Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists, Royal Australian College of General Practioners. AMH children's dosing companion 2018.
  4. Burridge N, Collard N, Symons K, Society of Hospital Pharmacists of Australia. Australian injectable drugs handbook [Internet]. Collingwood, Vic.: The Society of Hospital Pharmacist of Australia; 2018.

Reviewer/Team: Meredith Borland (ED Director), Dennis Chow (ED Consultant), Deirdre Speldewinde (ED Consultant), Gabrielle Anstey (ED CNS), Craig Hasler (ED CNM), Suzanne Ford (Senior Pharmacist), Karen Ho (Senior Pharmacist)
Last reviewed: Jul 2018


Review date: Jul 2021
Endorsed by:

Drugs and Therapeutics Committee Date:  Sep 2018


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