CONTINUOUS NEBULIZATION OF SALBUTAMOL PURPOSE A guideline for administration of continuous nebulized Salbutamol. EQUIPMENT Aeroneb Solo nebulizer Aeroneb continuous nebulization tube set Alaris pump (to infuse the medication into nebulizer) Salbutamol 5 mg/mL inhalation solution 10 mL vial Aerogen 60 mL syringe 0.9% Normal Saline (NS) PROCEDURE Rationale Preparing the medication: 1. Refer to the table below to determine required amount of Salbutamol and NS. 2. Draw up the required volume of Salbutamol and NS, and pour both The opening on the Aeroneb syringe is not compatible with any needle into one med cup. or transfer set; therefore, the only way to fill the Aeroneb syringe is to 3. Fill the Aeroneb syringe by directly drawing up the mixture from the draw up the medication directly from a wide-mouth container. med cup. 4. Attach syringe cap to Aeroneb syringe if not administering the medication right away. However, medication mixture should be The diluted Salbutamol mixture expires after 24 hours at room administered as soon as possible. temperature. Based on the pump flow rate, the Aerogen syringe will 5. If using the medication right away, attach the syringe end of the run over 6 hours. Aeroneb tube set to the syringe. 6. Prime administration set until it reaches the end of the tubing. The volume required to prime the tubing is approximately 3.65 mL. 7. Insert the syringe into the infusion pump. 8. Once the Aeroneb nebulizer has been set up and control module has been turned on, turn on the infusion pump to infuse at a flow rate of 10 mL/hour. Ensure the pump is labelled for CC.09.49 BCCH Child & Youth Health Policy and Procedure Manual Effective Date: Sept 10th, 2015 Page 1 of 3 CONTINUOUS NEBULIZATION OF SALBUTAMOL Inhalation Use only. Note: the Aeroneb syringe is for single patient use only, but can be reused for the same patient. Setting up the Aeroneb: 1. Connect the Aeroneb nebulizer to the Aeroneb T-piece. 2. Connect the T-piece into the inspiratory limb of the ventilator circuit, keeping the nebulizer in an upright position. 3. Screw the Aeroneb tube set to the nebulizer. 4. Connect the cable from the Aeroneb control module to the The Continuous Mode can only be operated under main power supply, nebulizer. Ensure the control module is plugged in to a main power and not by the internal battery power. supply. 5. Turn the Aeroneb control module on to the Continuous Mode by The Control Module must be turned on Continuous Mode to prevent the holding down the On/Off button for 3 seconds. nebulizer from powering off automatically after 30 minutes. Once continuous nebulization has started, observe the ventilator circuit During Continuous Mode, every drop of the medication into the for proper operation. The nebulization should be visible with regular nebulizer will be nebulized instantly. intermittent pauses. There should not be any accumulation of the medication in the nebulizer reservoir during use. Drug Dosage 20 mg/h Amount of 0.9% NS to add to Aerogen 60 mL syringe 36 mL Amount of drug (5 mg/mL salbutamol inhalation solution) to add to 60 mL syringe 24 mL (120 mg) Approximate total solution in syringe 60 mL Approximate final concentration of solution 2 mg/mL Alaris pump flow rate 10 mL/h CC.09.49 BCCH Child & Youth Health Policy and Procedure Manual Effective Date: Sept 10th, 2015 Page 2 of 3 CONTINUOUS NEBULIZATION OF SALBUTAMOL 1. Roles and Responsibilities: • Respiratory Therapist (RT) to set up the Aeroneb continuous nebulization tube set • RT to place the Aeroneb Solo nebulizer in-line of the patient’s breathing circuit • Registered Nurse (RN) to mix medication and label syringe • RN to set infusion rate on pump and label channel • Site to source checks to be done by both RN and RTs 2. Safety concerns: • IV vs inhaled – need to minimize risk of inadvertently administering IV • Use a dedicated pump on ventilator side of bed • Fluorescent orange laminated card on IV pole stating IV pump being used for inhalation medication 3. Prescribing: Suggested example: Salbutamol 20 mg/hour via nebulizer continuous inhalation for X hours then reassess DOCUMENTATION Respiratory Therapist to document on RT flowsheet: • Date and time continuous Salbutamol therapy was initiated • Drug dosage in mg/hr • Any changes in patient status • Indicate completion of site to source checks (at least every 3 hours) REFERENCES Aerogen Ltd. (2011). Aeroneb Solo System Instruction Manual. Retrieved from http://www.aerogen.com/uploads/datasheets/Aeroneb%20Solo%20DFU_EN_Rev%20J.pdf GlaxoSmithKline Inc. (2014). Ventolin Respirator Solution and Ventolin Nebules Product Monograph. Retrieved from http://www.gsk.ca/english/docs-pdf/product-monographs/Ventolin-nebules.pdf Papo, M.C., Frank, J., Thompson, A.E. (1993). A Prospective, Randomized Study of Continuous Versus Intermittent Nebulized Albuterol for Severe Status Asthmaticus in Children. Critical Care Medicine, 21(10), 1479-1486. CC.09.49 BCCH Child & Youth Health Policy and Procedure Manual Effective Date: Sept 10th, 2015 Page 3 of 3 .