1. Order a nebulizer machine
-Small Volume Nebulizer or Compact Compressor Nebulizer or any other durable nebulizer type that the patient’s insurance will pay for.
-Order Nebulizer Accessories (Mask, Adapter, Tubing, Filter, Mesh Cup & Medication Cup)
In most clinics, ordering a nebulizer involves entering a DME order into the EHR or filling out a DME form or both. In our EHR, we use “DME, Misc” order. Below is a sample note I include with my nebulizer orders for clarification.
Note to Durable Medical Equipment (DME): “Nebulizer machine and age-appropriate nebulizer accessories (Mask, Adapter, Tubing, Filter, Mesh Cup & Medication Cup) and other supplies as needed for administration of inhaled pulmonary medication. May substitute for comparable unit per insurance formulary.”
2. Order Albuterol Inhaled
A) For Bronchospasm
Children < 2
-Dose: Albuterol inhaled 0.05-0.15 mg/kg NEB q4-6h prn. Maximum: 1.25/mg/dose.
Children 2-5 years old.
-Dose: Albuterol inhaled 0.1-0.15 mg/kg NEB q4-6h prn. Maximum: 2.5/mg/dose.
Alternate dosing: Albuterol inhaled 1.25 – 2.5 mg NEB q4-6h prn.
Children 5 years and older.
-Dose: Albuterol inhaled 2.5 mg NEB q4-6h prn. Maximum: 10 mg/day.
B) Acute bronchospasm (e.g. asthma exacerbation in the ER or clinic setting)
Children < 12 years of age
-Dose: Albuterol inhaled 0.15-0.3 mg/kg NEB q1-4h; Start 0.15mg/kg NEB q20min x 3; Max 10mg/dose.
Alternative dosing: Start 0.15mg/kg NEB q20min x 3; then 0.5mg/kg/h continuous NEB.
Patients 12 years and older (use adult dose)
Dose: Albuterol inhaled 2.5-10 mg NEB q1-4h; Start 2.5-5mg NEB q20min x 3;
Alternate dosing: Albuterol inhaled 10-15 mg/hr continuous NEB.
Excellent Video on How to Use a Nebulizer on Kidshealth.org.
Reference
Epocrates