It is the process of administering vapourized salbutamol or airway constriction relievers (bronchodilators) in breathable mist through a tubing and face mask. This is done to relieve respiratory distress in a child with asthma, other respiratory conditions and situations of electrolyte imbalance e.g. hyperkalaemia.
Aims
· Relieve airway constriction
· Prevent complications and recurrence
· Provide supportive therapy
· Correct electrolyte imbalance
Types
· The process of nebulization depends on type of device to be used
· Jet nebulization – uses compressed gas to produce small particles of aerosols
· Ultrasonic nebulization – produces larger particles of aerosols through high-frequency vibrations. The particles are larger than that of the jet nebulizer
· Mesh nebulization – the liquid medication passes through fine and smooth mesh to form the smallest particles of aerosols
Requirements
a. Emergency tray containing the following:
b. Suction catheters (age appropriate)
c. Swabs c. Syringes and needles (various sizes)
d. Pulse oximeter
e. Oxygen mask
f. Ambu bag/self inflating mask
g. IV cannula and giving set (age appropriate)
h. IV fluid (Normal saline, Ringer’s lactate, 1/5NS in 4.3% dextrose, 10% dextrose)
i. Emergency medications
j. Salbutamol Nebules
k. IV Hydrocortisone
l. Ipratropium bromide Nebules
m. Glucometer and strips
n. Pulse oximeter
o. Sterile and disposable gloves
p. Sterile swabs
q. Air compressor (the nebulizer machine)
r. Small plastic container (nebulizer chamber)
s. Air tubing
t. Facemask
u. Suction apparatus
v. Vital signs tray
Steps
1. Receive child into emergency couch or chair in a sitting position
2. Establish rapport (Refer to steps)
3. Call for assistance
4. Perform five moments of hand hygiene
5. Provide minimal restraint to the restless child
6. Take emergency history from caregiver and assess the child
7. Obtain the weight of the child
8. Position child/caregiver at the nebulization station
9. Connect tubing to face mask
10. Prepare the chamber for medication administration
11. Fill in the chamber with the prescribed dosage of medication e.g. salbutamol
12. Add the required amount of normal saline if indicated
13. Assist the caregiver to hold the child in an appropriate position supporting the head and neck
14. Put on the device and observe the quality of the aerosol flow
15. Assist the caregiver to hold the face mask in firm position till the medication administration is completed
16. Continue to assess child for improvement in respiration
17. Monitor the child for adverse reactions to the treatment
18. Remove the mask from the child’s face when medication administration is completed
19. Wear gloves and clean nasal or oral secretions if necessary
20. Observe nil per os in children who are restless
21. Obtain IV access for other prescribed medications and IV fluids
22. Monitor RBS and manage appropriately
23. Express appreciation to child/caregiver for their cooperation
24. Return child to safe and desired position in bed
25. Disconnect tubing and mask from nebulizer, decontaminate and clean used items or storage
26. Document procedure and observations (manual or electronic)
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