Hypertonic saline mixed with other medications in the same neb session

[MyBabyCeline]

Is it ok to mix hypertonic saline with other medications in the same neb session? My DD is on Combivent (Ipratropium bromide + albuterol sulphate) and pulmicort (Budesonide) and I was wondering if we can mix the HS with them or should we do it seperately?

 

[Rebjane]

I would not mix Hypertonic saline in with those meds. My daughter is also on Albuterol, Pulmicort and Hypersal. We do Albuterol first; then hypersal, then VEST then Pulmicort last...time consuming yes.

 

[MyBabyCeline]

I would not mix Hypertonic saline in with those meds. My daughter is also on Albuterol, Pulmicort and Hypersal. We do Albuterol first; then hypersal, then VEST then Pulmicort last...time consuming yes.

Thank you Rebjane! Can't you mix the albuterol and pulmicort as well? We do that based on our doctor's recommendation.

 

[Rebjane]

Technically, I think you can mix Albuterol and Pulmicort to save time. We used to do that. But a pulmonologist suggested doing Pulmicort separately last after her VEST or CPT so the Pulmicort could sit in her lungs and not get coughed/beat out of her. Pulmicort helps with the inflammation so you want it to stay in the lungs and not get coughed out, kind of like soothing a boo boo at the end of a vest session....Hope that makes sense My daughter tends to have alot of issues with inflammation in her lungs so that's what we do.

 

[SadiesMom]

Our doctors told us to never mix any of the medicines. We aren't even allowed to use the same nebulizer cup without rinsing it between medicines.

 

[Aboveallislove]

Our doctors told us to never mix any of the medicines. We aren't even allowed to use the same nebulizer cup without rinsing it between medicines.

We were told we could use the Albuterol/Xopenex neb cup after it was finished for hyper-sal, which makes sense since hyper-sal is just salt water. Maybe check into that if your little one is doing hyper-sal as it would save 2 cups a day to wash.

 

[The Dot]

We were told we could use the Albuterol/Xopenex neb cup after it was finished for hyper-sal, which makes sense since hyper-sal is just salt water. Maybe check into that if your little one is doing hyper-sal as it would save 2 cups a day to wash.

I am an RT and was in charge of implementing the policies for the care of our adult CF patients at the hospital where I work. I spent a lot of time communicating with the Adult CF Clinic, so I will pass on what I learned from them and the CFF.

Always begin with your bronchodilator (opens up the airways): Albuterol or Ipratropium or Xopenex (usually mixed with normal saline)

Next use your Hypertonic Saline: Studies have been done mixing this with Albuterol in NON-CF patients, but for maximal benefit, you should do the Albuterol first. It will not hurt to use the same neb that your bronchodilator was in. HOWEVER, this "saline" will denature your Pulmozyme. That is why doctors do not want you mixing anything - so there's no confusion! Never put anything but Pulmozyme into your Pulmozyme nebulizer.

Next use your Pulmozyme (see statement above).

Your airway clearance device should be used during or after the Hypertonic Saline and Pulmozyme as this is when you are doing the most coughing and coughs will be most productive.

Finally, after the airways are clear of mucous, do your inhaled antibiotic (if you are on one at home) like TOBI.

At the very end, do your inhaled steroid (Budesonide, Pulmicort, Adviar, etc...). This calms the lungs and "seals" in the antibiotic. Yes, this is mixed with Albuterol sometimes, but in order to get maximum benefit, they should be done separately since one is at the beginning of your regimen and one is at the end.

Hope that helps.

 

[Aboveallislove]

Thanks so much Dot. That's exactly what our clinic said especially the pulmozyme!!!

QUOTE=The Dot;1040877]I am an RT and was in charge of implementing the policies for the care of our adult CF patients at the hospital where I work. I spent a lot of time communicating with the Adult CF Clinic, so I will pass on what I learned from them and the CFF.

Always begin with your bronchodilator (opens up the airways): Albuterol or Ipratropium or Xopenex (usually mixed with normal saline)

Next use your Hypertonic Saline: Studies have been done mixing this with Albuterol in NON-CF patients, but for maximal benefit, you should do the Albuterol first. It will not hurt to use the same neb that your bronchodilator was in. HOWEVER, this "saline" will denature your Pulmozyme. That is why doctors do not want you mixing anything - so there's no confusion! Never put anything but Pulmozyme into your Pulmozyme nebulizer.

Next use your Pulmozyme (see statement above).

Your airway clearance device should be used during or after the Hypertonic Saline and Pulmozyme as this is when you are doing the most coughing and coughs will be most productive.

Finally, after the airways are clear of mucous, do your inhaled antibiotic (if you are on one at home) like TOBI.

At the very end, do your inhaled steroid (Budesonide, Pulmicort, Adviar, etc...). This calms the lungs and "seals" in the antibiotic. Yes, this is mixed with Albuterol sometimes, but in order to get maximum benefit, they should be done separately since one is at the beginning of your regimen and one is at the end.

Hope that helps.[/QUOTE]

 

[LittleLab4CF]

Mixing saline solution with any of the usual nebulized medicines also changes the consistency of the solution. I've run my own tests combining various nebulizable medicines, and saline causes the combined medicines to become frothy and that extends the delivery time, even preventing all the medicine to be delivered.

When you look at the various meds, most require an organic solution to dissolve in and saline solution is water based. Simply put, mixing oil and water is not advisable here because they aren't miscible or soluble together. If you were to try to atomize oil and water in a nebulizer, the result will be a substantial amount of froth formed by microscopic bubbles of oil and water based mixture. This ends up either taking a very long time to finish or it gets tossed out.

Steroids are usually alkaloids and until we got rid of chloro-fluorocarbon propellants in rescue inhalers and such, chloro-fluoro carbon solvents were and are ideal delivery systems. Despite the environmental impact of such chemicals, the resistance to finding a new delivery method has merit. We have mostly switched to heavy alcohols or light solvents that can hold a considerable amount of lipids or possibly alkaloids.

This is not something that I recommend working around which could be done with a whetting agent. I believe the contributions suggesting what can and should not be taken together. Generally speaking, similar drugs in compatible solvents or complimentary drugs in compatible solvents can be combined in order to reduce time and redundant efforts.

Hopefully this helps figure how to comply with the minimum amount of time invested.

LL