Do you change neb cups?

[humphrey711]

Someone in one of my other threads (sorry for hogging) mentioned changing neb cups for different neb meds. I had no idea. My daughter is 8 and has been using the same neb cup for two meds for years. I also only change the cup every 6 months. Does this sound right?

 

[Ratatosk]

We have several neb cups, so I only have to sterilize them once a day in a giant pot of boiling water over my lunch hour. One for pulmozyme marked with a P, two for Tobi marked with a T and non-marked ones for albuterol/atrovent which is done three times a day. Tobi gets really sticky and pulmozyme should never, ever be mixed with anything, so don't want to risk residue from other meds

When we travel -- I take disposable nebs which I toss after each use.

 

[Aboveallislove]

Our cf clinc also stressed never to use a cup with pulmozyme and othemeds but sai it was ok to use the xopenex cup for hyper sal....we have about 9 cups and I use one in am for xopenex and immediately followed by hyper sal in same cup and then a new cup with pulmozyme. Then in evening one cup for xopenex and same cup immediately followed by hyper sal. We run them through the dishwasher every three days to clean and then boil them to sterilize.

 

[Gammaw]

We never use same cup for xopenex and tobi. TOBI cannot be mixed with anything. So we too have about 8 cups, 4 for xopenex unmarked and 4 for Tobi marked with a "T" using a sharpie pen. Rinse each after use, then wash with kitchen soap and water in a plastic bin, rinse, boil for at least 5 minutes and air dry on a paper towel. If you need more details, just holler!

 

[Ank]

Ya..M using 3 cup..2 for H.Saline and one for albuterol..I take albuterol b/w saline to avoid suffocation..
U cn use more then one cups depending on your needs...


If u r using tob,inhaling albuterol b/w tobi might help you to prevent bronchospasm.

And cups needs to be changed as described by manufacturer(that is around in 6 to 12mnth)

 

[imported_Momto2]

The only meds I mix are hypertonic and albuterol or mucomyst and albuterol. The nebbie cup get run through the dishwasher after every use. I usually have 4-5 going at one time, and I throw them out after about 6 weeks OR if I get an infection. I throw those out and start anew once I feel I have kicked the bug.

 

[Gammaw]

ImportedMomto2 - why do you throw them out after about 6 weeks? What cup are you using? The only reason I can see throwing them out at 6 weeks is if they are DISPOSABLES. Disposables are only good for one use - or perhaps a full day of use, but that would be it. There is not reason you should have them unless for example, you're traveling and can't clean them properly after use. So you throw them out. You can't boil disposables, which means you can't disinfect them.

So all nebulized CF meds should be nebulized in a REUSABLE nebulizer cup - Like Pari LC Plus - which can be boiled and therefore disinfected. They last 6 months before they need to be replaced. My concern here is that if you get an infection, and think it may be related to your nebulizer cup, you're probably right. The way to avoid that is to follow protocols for infection control. There are many sections on www.cff.com that talk about cleaning your nebulizer cups. I will be happy to point you to those details, or to give you more details here. Just let me know, or PM me and I will be happy to give you all the information you need. I'm not including it here, just in case I misunderstood and you have the reusable types already and are just being particularly cautious by throwing them out at 6 weeks. Please - this is a recurrent question, everyone is confused about it, and I will be happy to help. Just let me know if you want more details. . . . .

Blessings!

 

[ethan508]

I use 4 neb cups a day, albuterol then hyper-sal in morning and albuterol then pulmozyme at night. These all fit in a tupperware bowl that I fill with water and microwave each night. Then I have a dedicated colander that hangs across the sink to let them dry. If I'm ill I'll add in a few cups for extra treatments of albuterol and hyper-sal. I usually use neb cups until they have some sign of degradation (which often longer than 6 months). I should probably replace them sooner, but I have a tough time throwing out a neb cup that still works well (I use side stream neb cups for albuterol and Pari LC+ for other meds).

Like Gammaw said, cff.org has lots of good advice, I liked this set of slides: https://www.cff.org/PDF-Archive/Nebulizer-Care-in-the-Home-Slides/

 

[Gammaw]

Nice slides, Ethan
Here's a thread with a succinct rendition of the steps to disinfect that I posted previously.

http://forum.cysticfibrosis.com/thr...fection-Control?highlight=disinfect+nebulizer

 

[Aboveallislove]

Slightly off topic...but I was looking to get some disposable ones for emergencies and when I spoke with company and asked which you could use right out of bag without washing she said none...all the instructions say to wash sterilize first....but in hospital I thought I remember them just taking straight from bag???

 

[Ratatosk]

I always order a case of sidestream disposables before vacations and they're in individual plastic bags and I don't recall the literature saying anything about washing first. Here's the link to a site which sells that brand where you can access the literature. I toss after each use, not after two weeks though. http://justnebulizers.com/sidestream-disposable-nebulizer.html

BTW, I get the sidestreams elsewhere for MUCH less money. Don't think I've ever paid more than a $1-1.50 a piece for them

 

[imported_Momto2]

Actually Gammaw, I havent gotten a CF infection for over 10 years, and I dont culture much of anything, so I must be doing something right with regard to germ management. By "infection" in my previous post, I mean a simple cold. Which I pick up several times a year because I have 2 kids who bring them home from school and the gym.

 

[Gammaw]

That's amazing Momto2! No infection for over 10 years. You should be telling us all how you do it. Do you think throwing them out so frequently is one of the reasons? One of the recommended methods is to disinfect the cups in a dishwasher that gets above 158 degrees - perhaps that's what you have. Are these disposables or reusable cups? I'm wondering how the disposables hold up in the dishwasher; they melt down and warp if you boil them.

I know all about those colds from school - it always seems like the beginning of school in particular is certain to bring home a new bug for everyone to share. Of course, for us it can last 2 months instead of 2 weeks. I wish I knew how we avoid that every year. . . .

 

[jthomp]

Our clinic has stressed that the neb cups must be washed and disinfected after EVERY use. Here are the updated cf foundation guidelines that Gammaw posted a link to. (Our clinic used to tell us we could reuse the same cups all day and only disinfect once a day, but they finally corrected their instructions to match the guidelines.). This could be why there is so much confusion on this topic. We have 4 neb cups . . . 2 for AM treatment and 2 for PM treatment. We boil them all for 10 minutes each night. Once they've been used for a treatment, they are not used again until they are sterilized.

"Nebulizers: Cleaning and Disinfecting
59. The CF Foundation recommends that the following steps be performed for nebulizers used in the home as soon as possible after each use:

• a. Clean the nebulizer parts with dish detergent soap and water
• b. Disinfect the nebulizer parts using one of the following methods:

Heat methods:

• a. Place in boiling water and boil for 5 minutes
• b. Place in a microwave-safe receptacle submerged in water and microwave for 5 minutes
• c. Use a dishwasher if the water is more than or equal to 70°C or 158°F for 30 minutes
• d. Use an electric steam sterilizer

Cold methods:

• a. Soak in 70% isopropyl alcohol for 5 minutes
• b. Soak in 3% hydrogen peroxide for 30 minutes
  • i. Rinse off the cold-method disinfectant using sterile water, not tap water; the final rinsemust be with sterile or filtered (less than or equal to 0.2-micron filter) water
  • ii. Air dry the nebulizer parts before storage

Source of supporting evidence: 2003 CF IP&C guideline, Category II
2013 CF IP&C guideline consensus: 100%
Sections in the text: III.D.1; IV.E.3

60. The CF Foundation recommends that nebulizers used in the home should not be disinfected with acetic acid (vinegar), bleach solutions, or benzalkonium chloride (eg, “Control III”).
2013 CF IP&C guideline consensus: 100%
Sections in the text: IV.E.3". - See more at: http://forum.cysticfibrosis.com/thr...n-Control?highlight=disinfect+nebulizer#.dpuf

 

[jthomp]

Also, our clinic still recommends boiling 10 minutes instead of just the 5 minutes. Here's a link substantiating why. You have the scroll way to the bottom of the article (past where it says "conclusion" . . . which you might think is the end . . . to where you see the title "Boiling.") This article is referring to dish cloths, by the way, . . . but the same principles would apply to neb cups.

[h=3]BOILING[/h]Boiling is more labor intensive than the washer and dryer, but it would certainly kill all the germs, right? Laure Ingalls describes in detail how they boiled all their laundry once a week in her "Little House on the Prairie" books. I always assumed that if a germ was in boiling water for a mere 2 seconds, then it would die. So, I did an experiment where I drew 3 circles on my cloths with marker. I put 1mL of dirty water on to each circle. I pressed one spot from each cloth onto an agar plate for the dirty control. Then I boiled the cloths for 2 minutes, 5 minutes, or 10 minutes. I stirred occasionally while the cloths were boiling because they would balloon up, and I had to push them back under the water.



After the cloths were boiled, I let them cool briefly on my drying rack and then pressed the formerly dirty circles onto an agar plate. The plates were incubated for 24 hours. I tested Norwex, e-cloth, and cotton cloths over the course of a few experiments.










I don't know about you, but I am STUNNED that any bacteria could survive 2 minutes of boiling! There were even a few colonies that survived 5 minutes of boiling! So, boiling does a great job sterilizing a cloth, but it is best to boil for a full 10 minutes.

Here's the link to the full article . . . http://www.stopthestomachflu.com/norwex-cloth-independent-testing

 

[Ratatosk]

We were also told not to reuse nebs. With three vest treatments which include duoneb, tobi twice a day and pulmozyme once a day, we have multiple neb cups. I keep a large pot on the stove and boil nebs once a day for 10 minutes as well.

On vacations, we used to travel with a hot pot or make sure a kitchen was available; however, now I use disposable neb cups and toss after each use.

 

[imported_Momto2]

Gammaw, the ones I use DO melt if you boil them, but not if you run them through the dishwasher or run them through a baby bottle sterilizer. I havent gotten "CF" sick I think mainly 1) luck, 2) I avoid hospitals like the plague and refuse to be an in-patient, but when I 'm there for tests I always wear a mask and wash my hands every 30 minutes, 3) I avoid other CFers like the plague (no offense guys), 4) I am always washing my hands when out and about in daily life, 5) I have a rabid immune system which is currently, for lack of nothing else to do, attacking my lungs and causing severe asthmatic lung disease to add to the CF. That is what is currently killing my FEV1, lung inflammation. I'm on a chemo drug every 5 days to keep the little immune buggers in check. It's so ironic that I spend decades doing everything I could to build up my immune system and now I'm trying to suppress it as much as I can. Currently, if everyone in our household gets a 7-10 day cold, I have it for only 4-5 days AND I actually have BETTER breathing during the cold because the lung inflammation seems to reduce then. GO figure, its so messed up that when I am "sick" I actually feel and breathe better. The ironies of life never cease to amaze me.

 

[Aboveallislove]

Saw your note re the dishwasher and 158 degrees and wanted to share that we just went through the buying a new dishwasher process and none of the generally available ones get that high, much less for 30 minutes. I think the only one we saw that gets that high was a Bosch for $4000. Yes, $4,000! We do use the dishwasher for washing (I have horribly dry and cracked skin and it just can't take the washing even with gloves), but then we sterilize by boiling.

That's amazing Momto2! No infection for over 10 years. You should be telling us all how you do it. Do you think throwing them out so frequently is one of the reasons? One of the recommended methods is to disinfect the cups in a dishwasher that gets above 158 degrees - perhaps that's what you have. Are these disposables or reusable cups? I'm wondering how the disposables hold up in the dishwasher; they melt down and warp if you boil them.

I know all about those colds from school - it always seems like the beginning of school in particular is certain to bring home a new bug for everyone to share. Of course, for us it can last 2 months instead of 2 weeks. I wish I knew how we avoid that every year. . . .