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Nebulizer/MDI for toddlers advice

PICU   (1,903 Views | 12 Replies)
by PedsRN91 PedsRN91 (New) New

PedsRN91 has 2 years experience .

883 Profile Views; 14 Posts

Hi all,

I'm looking for advice from those with experience administering MDI/nebulizer treatments to toddlers. I've scoured the internet looking for resources but thought my best bet would be from those with actual experience!

Mostly looking for any recommendations to make life easier for those terrified 2 year olds who are fighting the nebulizer/MDI and for the parents/nurses attempting to administer the medication.

My patient today fought so hard that the provider eventually prescribed albuterol syrup (which I never knew existed honestly).

Any tips/info would be greatly appreciated.

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NotReady4PrimeTime has 25 years experience as a RN and specializes in NICU, PICU, PCVICU and peds oncology.

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OMG.... that used to be my nightmare! That I'd spend my entire stretch of shifts admitting toddlers on back-to-back nebs. If you're using face-masks with those nebs, there really are no tricks to making it easier. They're going to turn into greased pigs with incredible vocal range no matter what. Where I work now, we use a side-stream set-up of corrugated hose, with or without a mouthpiece. You can direct the mist at them while they're on a parent's lap, or while they're sleeping.

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middleagednurse has 50+ years experience and specializes in nurseline,med surg, PD.

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Try holding toddler on your lap, if possible, wrap one arm around child, and use other hand to entertain child, book, tablet, toy, etc. . If that doesn't work, Albuteral syrup sounds like a plan.

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HiddencatBSN is a BSN and specializes in Peds ED.

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NotReady4PrimeTime said:
OMG.... that used to be my nightmare! That I'd spend my entire stretch of shifts admitting toddlers on back-to-back nebs. If you're using face-masks with those nebs, there really are no tricks to making it easier. They're going to turn into greased pigs with incredible vocal range no matter what. Where I work now, we use a side-stream set-up of corrugated hose, with or without a mouthpiece. You can direct the mist at them while they're on a parent's lap, or while they're sleeping.

Doesn't administering it as blow by reduce the amount of medication they actually inhale?

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NotReady4PrimeTime has 25 years experience as a RN and specializes in NICU, PICU, PCVICU and peds oncology.

16 Articles; 7,358 Posts; 71,989 Profile Views

HiddencatBSN said:
Doesn't administering it as blow by reduce the amount of medication they actually inhale?

Not really. There are exhalation ports on the mask that allow a significant portion of the atomized med to escape along with their exhaled carbon dioxide. And if you can't keep the mask on the child's face, then you may as well squirt the med on the floor.

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AnnieOaklyRN is a BSN, RN, EMT-P and specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

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On the ambulance we use the full does and do it by blow by, they get what they get. If they are truly in severe distress they most likely wont be fighting to hard, and even if they are there are more ways to skin pig! Magnessium and Epi.

Annie

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canoehead has 30 years experience as a BSN, RN and specializes in ER.

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When I did pediatrics, long ago, we used masks. One toddler arm was placed behind my back, I used on arm to hold the other arm and force cuddle the child on my lap. If they were squirming and fighting, I crossed my leg over their legs to prevent them sliding down to the floor. I had the mask in my other hand, with fingers on the jawline bilaterally, so the mask would follow them if they turned their heads. We considered ten minutes of screaming (if it happened) an excellent way to increase absorption of an inhaled med.

I tried a less direct, blow by approach, but got a lot less med in, and kids would squirm worse because it was possible to escape the mist if they thrashed. I'd rather do one restrained dose that I know they got, rather than three half inhaled masks.

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NotReady4PrimeTime has 25 years experience as a RN and specializes in NICU, PICU, PCVICU and peds oncology.

16 Articles; 7,358 Posts; 71,989 Profile Views

Canoehead, you described the technique perfectly! I can still remember the headache and tachycardia I experienced from all the sidestream albuterol I've inhaled.

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Mickey9700 has 12 years experience as a RN and specializes in Pediatrics, PICU, Pediatric Urgent Care.

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It's not an easy task. I hope it's been figured out by now since it's 2019. I wish I had the time to do that fantastic technique, but I work in Urgent Care and the kids come in one after another and I'm the only RN there. I try to show the parents, but they "feel bad" for their kids, which I understand but I try to explain how dangerous it is if they don't get all the medication. Every time they cry, they breathe in more medication, so we look at it that way. 

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hppygr8ful has 15 years experience and specializes in Psych, Addictions, Elder Care, L&D.

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On 8/26/2018 at 12:09 PM, HiddencatBSN said:

Doesn't administering it as blow by reduce the amount of medication they actually inhale?

It does but they at least get some of it - We did this when my son was little only we put him in bouncy chair and get him playing which helped him to take deep breaths. If they are constantly fighting the mask their not getting much of the med either.

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7 Followers; 3,443 Posts; 24,342 Profile Views

Blow-by with full dose and they get what they get or you can MacGyver a HFNC  set up and administer it via nasal cannula.

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207 Posts; 1,271 Profile Views

I know this is an old thread, but I have some questions for those of you who work @ hospitals (regarding the coronavirus and influenza season):

1. What kind of PPE do you wear while administering these nebs? Is the procedure considered "aerosol generating" requiring a N95?

2. Do you wear any PPE while entering/exiting the room of an adult self-administering their neb?

Thanks, we get so little guidance in outpatient!

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