my dd just started this week. What a pain with the syringes and mixing! And it gets so bubbly I have to wait for it to settle. Can I just mix up all the bottles in the morning or do I have to mix them just prior to nebbing? Anyone know?
Colistin can be a real pain. When I first using it I mixed it just before nebulizing. I quickly stopped using the syringes. The empty ampoules from the saline that came with Cayston, proved very useful. I marked a batch of them at the 0.75 mL level, and then filled them with the 0.9% saline. This eliminated the need to measure the saline each time I nebulized. If you don't use Cayston, maybe you can try reusing the ampoules from hypertonic saline.
(Note: I'm quite sure that exact amount of saline used is not critical.)
The foaming is a know problem which can be minimized by handling the reconstituted Colistin gently.
Colistin is also available pre mixed. It's much easier to use. You should check with you doctor and insurance provider to see if you can get it. There is no mixing needed but foaming is still a problem.
When nebulizing the Colistin I used a nose clip to minimize its unpleasant taste. After using it for a while in the Cayston off months, I had problems tolerating the Colistin and stopped using it.
thanks Stephen, that's a good idea! Right now they have me mixing 4 ml of saline into the Colisitin powder and then my DD has to neb half of it. I'm wondering if I can save the other half for the next treatment. I'll see about getting it pre-mixed as well
Colistin is a pain until you get the hang of it. I don't use syringes. Just pop the rubber top off, estimate 4mls (although we use water for injection, not saline) put the rubber cap back on, gently shake and then I just let it sit for 5 minutes and it dissolves without the bubbles.
Sometimes the top might slightly pop up but I just push it back on. Not sure where you are, I'm in Australia, so we only have the one you need to mix. The taste doesn't bother me at all. I find it better than tobramycin and definitely more tolerable than amikacin - thankfully!
Yes once mixed it needs to be refrigerated and can be used up to 24 hours after mixing.
Not mixed it doesn't have to be refrigerated.
Just squirt the sterile water into the Colistin VERY slowly and that helps with bubbling. And roll it do not shake it.
my daughter has used colistin for a good 7 years now and we pull down the seal and pop off the bung as already mentioned. I recommend you tap the vial before you add the saline to loosen the powder first. Then when you've added the amount prescribed, we swirl the vial around for about 15 seconds and leave it to sit for a minute and it mixes well without the dreaded foam up that can happen if you shake it.
We have used colistin many times in the past. To limit the amount of foam, make sure you are injecting the sterile water in slowly and also removing an equal amount of air from the vial. We also found that using 6 cc of diluent helps with not only the foam problem, but also helps the powder dissolve more quickly. This works fine if you are using half for the eflow. If you have to use the whole amount for a regular neb, 6cc may be too much volumn. Hope this helps.
Hiya I've added this FDA link because it warns against prematurely premixing this stuff as it turns toxic over time and can damage the lung tissue. It does say it can be mixed up to 24hrs but advises it should be made up just before nebulising. I've also read more recommendations saying no more than 12 hours and others 8 hours. Personally from my own experience I would recommend making it up just before whenever possible. I took colymicin a few years back and was advised that I could make up both doses at once, which I did. I reacted quite badly to it and am unsure whether this was a contributing factor to the devastating and irreversible effect it had on my lung function.
I was surprised to hear that people are using syringes for this. Everyone I know takes the cap off squirts the sailing in and puts the cap back on and shakes it up. We've never had a problem with foaming just from the mixing. Perhaps try it without The syringe and see how it goes.