Salbutamol - Continuous nebulised

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 continuous nebulised salbutamol.

Medication

  • Salbutamol is a β2 agonist
  • In severe asthma it can be given as a continuous nebuliser.

Actions

Salbutamol acts on β2 adreno-receptors in the bronchial smooth muscle of the lungs to allow bronchodilation.

Indications

Acute severe asthma not responding to initial treatment with intermittent inhaled salbutamol.

Adverse

Although the incidence of all side effects is very low following intermittent inhalation, the continuous nebulised route commonly induces side effects, these may be so severe that the drug has to be discontinued.

  • Peripheral vasodilation with a reflex tachycardia
  • Irritability, agitation, tremors, hyperactivity, headache
  • Nausea and vomiting
  • Hyperglycaemia
  • Paradoxical bronchospasm
  • Paradoxical hypoxaemia
  • Hypokalaemia.

Dosage

The dosage is the same regardless of the child’s age or weight, as the actual inhaled dose will be adjusted by the patient’s tidal volume.

Preparation

  • Chart 100mg salbutamol in 50mL of 0.9% saline on the drug chart
  • Using the 5mg/2.5ml nebules, draw up 20 nebules = 100mg in 50mL of solution
  • Add this to 50mL of 0.9% saline
  • This gives a final solution of 1mg/mL
  • Deliver this volume to the nebuliser chamber via infusion pump.

Administration

  • Fill nebuliser bowl with 4mL of solution prior to commencing
  • Run oxygen flow of 8L/min via the nebuliser
  • Run infusion pump at 25mL/hour to deliver 25mg/hour
  • Check the nebuliser regularly to ensure it is not over-filling.

Special

  • Position the patient sitting upright
  • The length of time of continuous nebulised salbutamol should be based on the clinical response. Discuss with a senior doctor.
  • Consider the need for treatment escalation (to intravenous therapy) and plan for this
  • Ensure appropriate monitoring – continuous oxygen saturations and cardiac monitoring
  • Consider Paediatric Critical Care Unit review.

Nursing

  • The patient will often require 1 : 1 nursing care during this time and record the following observations:
    • Vital signs 5-30 minutely P,R,SpO2 (BP if clinically indicated)
    • Temperature 2-4/24 as clinically indicated
    • Description of indicators such as mental state, general appearance, air entry, breath sounds, respiratory effort (ie: degree and type of recession), nasal flaring must be documented at least 30 minutely.
    • Close observation for 30 minutes after cessation of continuous nebulisers (to monitor for signs of hypoxaemia).

Reference

  1. Salbutamol. Australian Medicines Handbook Pty Ltd. 2013 July. Accessed online at www.amh.net.au

Reviewer/Team: Meredith Borland (ED Director), Dennis Chow (ED Consultant), Deirdre Speldewinde (ED Consultant), Gabrielle Anstey (ED CNS), Craig Hasler (ED CNM)
Last reviewed: Apr 2017


Review date: Apr 2019
Endorsed by:

Director, Emergency Department Date:  Apr 2017


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