Appendix 16. Epinephrine nebulization


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

Weight4.5 kg5 kg6 kg7 kg8 kg9 kg10-17 kg> 17 kg

Epinephrine
(1 mg/ml amp.)

2 ml2.5 ml3 ml3.5 ml4 ml4.5 ml5 ml5 ml

0.9% NaCl
to be added

2 ml2 ml1 ml1 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.