Management of Administration of Nebulised Salbutamol

Description

• Clear, colourless respirator solution 1 mg/ml in 2.5 ml sterinebs.

• Salbutamol respirator solution is charted on prescription chart in mg/dose.
• The order states the base fluid to be used and amount. Nebulise until empty or spluttering: maximum time 10 minutes.

Administration

Nebulised

1. Ensure nebuliser is in working order.
2. Salbutamol is diluted in NS. Make up to 4ml.
3. Salbutamol may be administered with sodium cromoglycate or ipratropium, if administration times coincide. It is not recommended to mix sodium cromoglycate (Intal) and ipratropium nebuliser solutions. Ensure total volume is made up to 4 ml with NS. Mix immediately prior to use. Discard if any turbidity or precipitation occurs.
4. Nebulisation via a mask:

• Use a mask with large side holes - not small ones, to ensure no CO2 build up.
• Nebulise using a flow of 8 litres oxygen/air per minute.
• Nebulise until dry or spluttering: maximum 10 minutes. Tap nebuliser occasionally to release solution into the reservoir.

5. Nebulisation via a ventilator circuit:

• Use a pre-packaged ventilator nebuliser kit.
• Attach into patient Y piece at unused temperature port (for Infant Star Ventilators replace the nondisposable patient Y with a disposable patient Y).
• Use a flow of 6 litres oxygen/air per minute through nebuliser and reduce ventilator gas flow to make a combined flow equal to that which baby is currently receiving (i.e. this will normally be 4 litres/minute to make a total flow 10 litres/minute).
• Nebulise until dry or spluttering: maximum 10 minutes. Tap nebuliser occasionally to release solution into the reservoir.

6. Soaking in sodium hypochlorite solution is NOT recommended. Separate pieces. Rinse, dry on paper towel. Store dry in covered container.
7. Change nebuliser weekly and PRN.

Observation and Documentation

1. Assess for signs of adverse effects.
2. Monitor apex beat, rate and rhythm regularly. Apex beat must be taken immediately, prior to administration (preferably an undisturbed rate). If apex beat is >180/min withhold medication and notify doctor / NS-ANP immediately.
3. Monitor SaO₂ during administration of salbutamol and for up to 30 minutes after.
4. Continue to provide oxygen and ventilatory support as appropriate.
5. Ensure ventilator pressures remain unchanged during nebulisation.
6. Document patient response to therapy.

Storage

• Store at room temperature until use.
• Discard after opening.

Selected References