Appendix 16. Epinephrine nebulization

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    Nebulised epinephrine (adrenaline) is indicated in severe acute laryngotracheobronchitis (in combination with dexamethasone by IM injection).
    It must be prescribed by a doctor and should only be repeated on medical prescription.

    16.1 Dosage

    0.5 ml/kg/dose (using 1 mg/ml ampoule). Do not exceed 5 ml of nebulised epinephrine.

     

    See table.

    16.2 Equipment

    • Epinephrine, 1 mg/ml ampoule(s)
    • 0.9% sodium chloride, if necessary
    • Nebuliser + electric air compressor
    • Clean tray
    • Single patient equipment: paediatric mask + tubing
    • 5 ml syringe + 19G needle, single use

    16.3 Technique

    Aerosol preparation (just before use)

    • Verify the prescription: name, prescribed dose, concentration of epinephrine in the ampoule.
    • Prepare the equipment.
    • Wash hands with soap and water or disinfect them with an alcohol-based solution.
    • Open the nebulizer.

    • Using the syringe, place the prescribed amount of epinephrine in the lower part of the nebulizer.
    • Add enough 0.9% sodium chloride to obtain a total volume of 4 to 4.5 ml in the medicine cup.

     

    Nebulised epinephrine dose by age or weight

    Age

    1

    month

    2

    months

    3

    months

    4-6

    months

    7-9

    months

    10-11

    months

    1-4

    years

    		 > 4 years
    Weight 4.5 kg 5 kg 6 kg 7 kg 8 kg 9 kg 10-17 kg > 17 kg
    Epinephrine
    (1 mg/ml amp.)    		 2 ml 2,5 ml 3 ml 3,5 ml 4 ml 4,5 ml 5 ml 5 ml
    0.9% NaCl
    to be added    		 2 ml 2 ml 1 ml 1 ml – – – –

     

    • Screw the top of the nebulizer back on.

     

    • Connect the nebulizer to the mask.

     

    • Dispose of sharps in a safety box.

    Administering the aerosol

    • Explain the procedure to the child and the person accompanying him: the inhalation lasts about 10 minutes; keep the mask on and breathe slowly and deeply the entire time.
    • Have the parents hold the child in a half-seated position.
    • Clear the nose, if necessary.
    • Attach the tubing to the compressor.
    • Start the compressor. Make sure there is mist coming out of the mask.
    • Place the mask over the child’s mouth and nose; secure it in place with the strap.
    • The inhalation should last no longer than 10 to 12 minutes. Stop the compressor after 10 to 12 minutes (or sooner, if all of the medicine has been nebulised).
    • Record the procedure in the patient’s chart.

    Monitoring

    • Before nebulization: heart rate, respiratory rate and, if possible, SpO2.
    • During the nebulization and for 4 hours afterward:
      • general condition, level of consciousness, respiratory rate, and SpO2;
      • signs of improvement: decreased stridor and improvement in ventilation, level of consciousness and SpO2;
      • alert the doctor in case of pallor, tachycardia, arrhythmia, or drop in SpO2 (< 90%).
    • Record the monitoring data in the patient’s chart.

    16.4 After using the equipment

    • Discard the tubing and mask.
    • Disassemble the nebulizer and clean all of the parts in soapy water, taking care not to damage the jet (do not use a brush).
    • For equipment maintenance (jet, compressor air filter), refer to specific protocol.
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