Lots of Nebulizers – Need Advice on Keeping them Clean

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Hail2Pitt

Guest
Hi all,

I’ve just had another inhaled antibiotic added to my regimen, so I’m now doing six nebulizers a day. This includes hypertonic saline twice a day, inhaled amikacin twice a day, and now inhaled colistin twice a day.

With my busy schedule, I’m struggling to figure out how to keep all of my nebulizers clean and sterilized. Before starting the colistin (when I was just on saline and amikacin), I’d decided to buy 21 nebulizers. That way, I could clean and sterilize them all at one time, and then have a supply to last me the week (each day I’d use one for two doses of hypertonic saline, and then one for each dose of amikacin). But now that I have two additional treatments to do each day, I’m not sure how to handle this.

I just don’t have time to be cleaning and sterilizing nebulizers every day, and I think cleaning them a few times a week would be tough as well. What do you all do to ensure your equipment is clean, especially when you have to do several nebulizers a day? Any tips would be greatly appreciated!

Thanks!
 
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Aboveallislove

Super Moderator
We have about 21 as well but only use 2 in am (one for xopenex and hyper-sal--first one and then the other--and then a new one for Pulmozyme). Anyway, we use baskets (baby dishwasher baskets) and run a dishwasher full of them all at once and then we boil them all after. (dishwashers make me nervous but get the stuff out especially after sitting for a week...) We shake and rerinse to get all the soap out and it works good and we only do 1 x a week. Another thought is if you are swamped at times is to just buy in bulk disposable ones and toss. That can give you a break during work week etc.
 
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Hail2Pitt

Guest
Thanks for the reply! I do what you do - baby dishwasher baskets, run a dishwasher full of them once a week, and then boil. Buying disposables is a great idea. I just need something to get me through this time of two extra nebulizers a day, so I'm going to look into that.

My insurance doesn't cover all these nebulizers, so I've just been buying them from justnebulizers.com, as the price seems pretty good. But, is there a place that you can recommend?
 
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Aboveallislove

Super Moderator
Your insurance should cover 1 for each med...maybe call pharmacy home med and push...I get at allegro.com when they have sales of 60% off of list. I also get name brand hyper sal which has a copy of 15 for three boxes and comes with one neb per boxes. For disposable call your rt folks and ask if they can sell you at cost a case of disposable or the clinic related home med....they sold us at cost or very close for disposables....did for one month of horrendous extra stuff going on and wow what a help that made!
 
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Ratatosk

Administrator
Staff member
DS does 3 vest treatments a day with duoneb, plus pulmozyme once a day and every other month he does Tobi twice a day. So I have a big giant pot and boil nebs over my lunch hour once a day. On vacations, I have purchased a huge case of disposable sidestream nebulizers which can be used with the duoneb (albuterol/atrovent) and pulmozyme, but not Tobi. Pari makes a disposable neb which is appropriate for Tobi; however it's flippin' expensive and for some weird reason, it doesn't have a lid, so IMO a lot of med gets wasted. I bring reusable pari neb cups for the tobi and boil them in a little hotpot in our hotel or if a kitchen is available -- boil on the stove. I know some people use microwavable bags for sterilizing breast pump parts, too.
 
D

Dank

Guest
This seems so overwhelming for me, how do you guys manage? I have a hard time having the energy to clean the nebs after use.
 
M

mamaScarlett

Active member
Deb said:
I also like to have several nebs so that I am not disinfecting every day. I used to use the dishwasher method but I now buy the bags that are used by nursing mothers to disinfect. They are made by Medela. Link here: http://www.medelabreastfeedingus.com/products/185/quick-clean-micro-steam-bags
Once a week I disinfect all nebs using this bag and the microwave. Note: you cannot put the disposable ones in here as they will melt.
Click to expand...

I use 7 total every day. I have a bottle sterilizer on the counter. I rinse them out in a large tupperware and then throw them all in the sterilizer at the end of the day. 10 mins later put them on the counter to dry and start all over the next day. Pretty simple. Better than culturing additional bacteria bc I've used dirty nebs.
There is no reason to not have enough nebs, the center should give them to you, or you buy good ones online for $10-15 a piece.
 
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Gammaw

Super Moderator
Our insurance will send two at a time but no more - one for each nebulized med. We use 4 a day. But they will send them however often I call within reason. So I bought 8 on my own to start. Then call insurance each month and save the two they send so I have eight more by the time I'm suppose to switch them out - every 6 months. Once used I put them in a stainless bowl after rinsing. Every other day I wash them by hand With soap and a paper towel or soak them in soapy water for a few minutes. Rinse them. Then boil them in water with vinegar for 10 minutes. I place them on a jelly roll pan pre washed with clorox and covered with fresh paper towels. I cover them all with a paper towel while air drying. I can place the jelly roll pan in a cabinet or on a shelf to keep it out of harms way.
Our clinic said we could use the same neb twice before sterilize but that would make me very nervous!
 
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erock77

Member
Wow! I didn't know people stock up like that. I'm 36 and have boiled nebs maybe 5 times. Way too much effort. I use a plastic reusable microwavable sterilizer for baby bottles. I use 3 nebs each day. I rinse them out with tap water just to get off residue, dismantle and put all 3 in the container. Put in maybe 1/4 cup of water, set the microwave for 3 minutes. Then set them out to dry and use the one I need. The whole process is like 4 minutes. Just search 'bottle sterilizer microwave' in Amazon (or somewhere). I don't see the exact one I use anymore, but there's a bunch of similar ones.
 
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Gammaw

Super Moderator
I think the verdict on baby bottle sterilizers is still out. I've seen it both ways - sufficient to disinfect or not sufficient. I think you can find some helpful threads on baby bottle sterilizers on this forum. Sterilizing by boiling really isn't hard. Just get one dedicated stainless steel stock pot and possibly a large basket to fit inside it if you don't want to fish 'em out one by one when they're done. I add vinegar because we have hard water. 10 minutes boiling while you're doing other things and they're all done. Either pull out the basket, shake it and let them drain a few seconds before you dump them out on your paper towels. Or use some tongs to pull them out one by one.
 
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london_gooner

New member
Im doing 5 nebs a day and I use this baby bottle steriliser in the microwave http://www.amazon.co.uk/Philips-AVE...2547&sr=8-1&keywords=philips+avent+steriliser

Its only cheap and you can fit 3 nebs in ok, a little bit of water in the bottom chamber and its done in 6 minutes....... I then sterilise my nebs once a week in water/sterilising liquid as well...........

I've only started doing the microwave thing in the last couple of years but all the things that we have learnt about infections over the recent years in particular means its well worth it in my opinion..............
 
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Gammaw

Super Moderator
Wouldn't it be nice if we can do that and feel comfortable with it! I watched it twice. I don't know if it's meant to specific to an e flow or altera Nebulizer, but I like the way they shake it up in soapy water first, before sterilizing. That's how I do a large number of them at a time, instead of hand washing each one with soap. But im also cleaning the Pari LC Plus nebulizers. It also says don't use a microwave sterilizer under any circumstances. They never say why? If they are talking about Medela bags, my own RT suggested them at one time, not that long ago. I use them for sterilizing all the syringes for my sons liquid medications and for his aero chamber since they tend to melt when boiled on the stove. I understood a microwave bag and the baby bottle sterilizer were good for things that would otherwise melt when boiled. Although if you try putting a disposable Nebulizer in a steam bag, you'll have a mess! So . . . . The video is three years old, which gives me pause. And it's specific to an e flow and altera Nebulizer. I'm just not comfortable using it for the LC Plus. And the Pari booklet does not endorse that either. I've called Pari before and they suggested using Control III as an alternative, but I've heard that tends to leave a residue on the parts.
It would be really nice if the CF Foundation would develop a protocol that could be disseminated with consistency through the Centers and their Resoiratory Therapists. Meanwhile I guess everyone has to figure out what makes them comfortable in consult with CF Team. Back to boiling. . . .
 
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Aboveallislove

Super Moderator
Gammaw...rather than sterilize syringes or wash for that matter, I buy a case of sterile syringes and use and toss. Very cheep and worth my time. Let me know if interested in details.
 
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Gammaw

Super Moderator
Hi AboveAll. We use at least 4 a day and the ones from Walgreens fit inside the bottle stoppers they give us for his liquid meds. Have you seen them? Keeps from having to pour the last half bottle of liquid out to draw up. The syringes comes with a stopper that screws into the top of his liquid med bottles (compounded). Then you can insert the syringe into the hole, and turn the bottle upside down to draw it out into syringe with no spills. What type of syringes do you get and where do u get them in bulk? I'm definitely interested. I wind up with about 30 in a bag to sterilize at a time!
 
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Ratatosk

Administrator
Staff member
Gammaw, we did the same. bought enough syringes to toss after each use. I preferred the baxa brand, so it took some searching online to find them, but with DS' azithromycin, it was soooo sticky and difficult to draw out of the bottle that I needed the stoppers that screwed into the bottle. I DID reuse the stopper, which I had to buy on my own, our pharmacy didn't have those. With the stoppers I'd wash with hot soapy water and them put them in a cup of boiling water to make sure they got clean. Problem with the oral syringes is they never ever seem to get completely dry. I just used one the other day to drain a bunch of liquid out of a hot dish (don't judge! I know I'm weird) and washed it and it was will wet inside a couple days later. Tossed it.
 
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Aboveallislove

Super Moderator
http://www.allegromedical.com/syrin...-needle-regular-luer-tip-sterile-p550807.html
Use these for everything but vitamins because they don't fit in the aqua Adeks. So use for Zantac, Prilosac, milk of magenisia. For vitamins we use http://www.allegromedical.com/syringes-c570/3-ml-bd-luer-lok-syringes-bd-precisionglide-needle-combination-regular-bevel-regular-wall-detachable-needle-p554559.htmlThose are skiny enough to fit in the vitamin bottle. Allegro erican has 50 or 60 percent off list price regularly...now 50off and free shipping. Best deal I've found for all our stuff.
 
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Ratatosk

Administrator
Staff member
I also found a place that had different colored syringes, different sizes because DS had so many pink medicines with similar dosage. Actigall 3 times a day was pink, Zithromax once a day, darker pink, Keflex 4 times a day pink, Adeks twice a day, septra twice a day was pink. I would draw up the days meds and keep them in a baggy in the fridge, so I didn't have to draw each individual one several times a day.
 
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