Your opinions on nebulisers please

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anonymous

New member
Howdy,

I am permanently on inhaled tobramycin twice daily. Thankfully... i have two mouth pieces and so can wait for them both to be used to wash them up, meaning they get washed daily. I usually use warm soapy water or otherwise boil them with some vinegar. I am pretty good with treatments... do them and physio religiously, same with taking all meds.

My question is, on the VERY RARE occasions where i 4get to wash them and it is already time for the next treatment.... is is ok to use a "dirty" neb occasionally?

Sometimes i only leave 15 mins before work to do the neb, and if it isnt clean i dont exactly have time to clean, dry AND do it! So about once every fortnight or so i will use a non-cleaned neb

My firend (with cf) said if i dont clean them, theirs no point doing them cuz of the chance of bacteria growth is worst then the benefits of the antibiotic treatment istself...

IS it really THAT bad... as in... well, should i just not do a treatment if its not clean? Might seem trivial, but id appreciate ur thoughts...

thanks, Chloe
 
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anonymous

New member
OMG if that is the case I am in trouble! They told me to only clean them a couple times a week! I sure hope not..................
 
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Emily65Roses

New member
Everynight when I'm done they get put, with dish soap, into really hot water and they sit for the night. The next day I rinse them off, also with hot water. I very rarely forget to clean them anymore, but it still happens. And I think your friend may be right, but I've also used dirty nebs. So I don't really have much advice for you here. Just wanted you to know that I've done it too. <img src="i/expressions/face-icon-small-wink.gif" border="0">
 
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anonymous

New member
If I've forgotten to clean my child's neb cup and need to use it asap, I just wash it very quickly with hot sudsy water, rinse it and use a clean cloth to dry it. I try to do that at least 1-2 times/day if not between every tx. Two-three times/week I soak it over night in hot vinegar water. Our pulmo clinic said that was sufficient...
 
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anonymous

New member
It's recommended to clean them with hot water and soap for two reasons. One, it keeps the neb lasting longer because these antibiotics can make them very sticky. The second thing is, as someone else mentioned, to keep bacteria away. OF course nobody is perfect, but maybe you need to set up a new system, using 7 nebulizers at a time for a month, one for each day, that way there are no worries of clean, not clean...
 
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anonymous

New member
Hi,
According to the CF foundation, vinegar water or pure vinegar does not kill all germs associated with CF, so the only way to truly disinfect them is to boil them every day or a couple times a week at least. I used to soak my parts in hot soapy water overnight, but the water gets lukewarm at a point and that is when pseudamonas grows rampant, so recently, when I don't have time to scrub them and rinse them right away, I rinse them with water and put them in a container. Then, when I run the dishwasher, I put them all into a basket and wash them all that way. This way, the excess meds. have already been rinsed off though I don't necessarily wash them right away. I have heard also that you MUST wash them with hot soapy water before doing another treatment.

Here is the link to CFF's information on cleaning nebs. : http://www.cff.org/living_with_cf/respiratory/
Click on "Stopping the Spread of Germs" (it is in PDF format). Then, scroll down to page 2 where you will find info. on cleaning and disinfecting nebs.

I never knew there were particular steps we have to take to insure germ control, but I was very enlightened after reading this article, and maybe this can help with the confusion over how to wash them and what to do.
SR<img src="i/expressions/face-icon-small-smile.gif" border="0">
 
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anonymous

New member
All manufacturers of Nebulizers make it clear, usually on their packaging or inserts, that nebulizers are not to be cleaned in vinegar-it comprimises the integrity of the plastic and therefore the entire product. The recommended way from the manufacturers is to wash the nebulizers after each use with hot water and ANTIBACTERIAL soap. There is the occasional "can't wash it RIGHT now" , but for the most part you should try not to make that a habbit.

Julie
 
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anonymous

New member
it is fine not to wash it after every treatment. Be sure though to "shake" out any left over medicine post treatment. The way most professionals recomend you clean the circuits is once daily. Wash one and while it is drying use the other, alternating days. Be sure to use "mild" dishwashing liquids, ivory or dove. The others have more respiratory irriatants. Also rather than vinegar you might consider peroxide, let it soak for half an hour. It kills everyhthing and dosen't leave the odor.


Luke RRT 29/cf
 
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anonymous

New member
What about dishsoap and bleach, rinse and dry? I read that on another website. Would that be ok do ya think?

<img src="i/expressions/face-icon-small-smile.gif" border="0">
 
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anonymous

New member
I think bleach is also mentioned on the CFF website mentioned above. It specifies how much is needed in water to kill the germs. I wouldn't do anything other than what the article says. I don't think its good to not wash them between treatments. They specifically mention that they MUST be washed between treatments, and being the CF foundation, I trust they have studies to back this up and know more than anyone what the protocol is. They should be the go-to resource for all caregivers of CF, in my opinion.
<img src="i/expressions/face-icon-small-wink.gif" border="0">
 
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Emily65Roses

New member
I don't know about whether or not you "should" but I've been taking my Pulmo in a neb for 12 years, and I have always soaked them in hot water with dish soap.
 
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anonymous

New member
Every couple days, I soak them in hot water and vinegar. Then I take them out and put them in the microwave for about 30-45 seconds.
 
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ClashPunk82

New member
What I do is after I use it I soak it in soapy water and then after like an hour I rinse it out. Every couple of days I boil it to make sure there is nothing growing in there.

Nicole 22 CF
 
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anonymous

New member
Vinegar has been proven to weaken the plastic (it eats away at it) and therefore comprimise your neb treatments. I would consider using another method other than vinegar.

Julie
 
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seasprite

New member
Julie --

I've never encountered anyone who recommended the use of antibacterial soap for cleaning nebulizers. In fact, the Centers for Disease Control and Prevention have expressed concern about the use of antibacterial soaps even for handwashing (in most cases, alcohol-based hand sanitizers are preferred) because of the potential risk of promoting antibiotic resistance.

Pari's instructions (printed 9/04) for disinfecting the PARI LC Plus and LC Star reusable nebulizers include the following language:
"Every other treatment day, soak all parts of the PARI Reusable Nebulizer (except tubing, mask and tubing adaptor) in a solution of 1 part distilled white vinegar and 3 parts hot tap water for 1 hour."

The DeVilbiss Pulmo-Aide patient guide currently available on the Web recommends disinfecting nebulizers in 1 part white vinegar, 3 parts hot water.

A 1998 paper from Bonnie Ramsey's CF Research Center in Seattle tested the Pari LC and 4 disposable nebulizers (Air Life Misty-Neb, Micro Mist, T Updraft II Neb-u-mist, and Acorn II) over 100 repeated use and cleaning cycles with saline, tobramycin, gentamycin, or a mixture of albuteral and cromolyn. The conclusion was that, "When properly maintained, there was no trend of deterioration of performance with repeated use." "Proper maintenance" was defined as "the nebulizers were washed after each run with soapy water, rinsed, and allowed to air dry before they were run again. Each nebulizer was also subjected to a daily 30-min soak in 2.5% acetic acid (1 part vinegar plus 1 part water), followin the manufacturer's recommendations."

So when the CF Foundation issued its new guidelines for nebulizer cleaning, the warning not to rely on vinegar as a disinfectant was based on evidence that vinegar could not kill all the bacteria that pose a particular risk in cystic fibrosis. There was no implication that vinegar was bad for the nebulizer plastics. This is not surprising, given that vinegar is a very weak acid which is often sold and stored for long periods in plastic bottles, consistent with the lack of any discernable damage to the plastic nebulizers in the Ramsey et al. study. If you are aware of evidence that vinegar causes deterioration of nebulizers, perhaps you had better notify PARI, DeVilbiss, Bonnie Ramsey, and the CF Foundation, all of whom seem to be unaware of that information.

Bambi, Jordan's mom
 
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seasprite

New member
Chloe,

I really sympathize with how hard it is to keep up with the nebulizer cleanings. I hate it when my son goes on TOBI for that very reason.

Nevertheless, it's not a good idea to resuse a TOBI nebulizer that hasn't at least been rinsed very thorougly and allowed to dry. The reason is that bacteria can grow very quickly in liquids left around at room temperature. And the only bacteria that could grow in TOBI residue would be tobramycin resistant strains, which is the last thing you want to cultivate. We never re-use a nebulizer without cleaning it with soap and water and boiling it, but (as another poster recommended), we always have several clean nebulizers available, so we can get through at least two treatments before we have to go through the disinfection process. At the very least, see if you can't rinse out your nebulizers thoroughly with boiled water after use -- tap water is not recommended by the CF Foundation because it also can contain resistant bacteria.

Bambi, mom of Jordan (16, w cf)
 
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anonymous

New member
Boiling is only alright for some kits, the resuable kind, not the kind you bring home from the hospital. Be sure that you look at your kit after each boil. If you notice that your tx times are getting longer or is more liquid than mist, you have messed it up. Remember the circuits are designed to produce particles <5 microns in size to get deeper in the lungs, if you damage the circuit even a little bit you aren't getting a "quality" treatment.

A random idiot thought, I was boiling my flutter once and kind of forgot about it. yep, that's right forgot about it! Long story short, the only survivor was the metal ball chilling in a pool of plastic goo.

Luke.
 
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anonymous

New member
Hi,

the easiest thing to clean them ist to use a "cleaner for baby-milk-bottles", where you put in a little amount of water, then it starts boiling and the steam is cleaning everything inside.

Uli,42,Germany
 
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anonymous

New member
On boiling, I've tried that but have destroyed a few neb kits that way. DOes anybody know which ones are boilable? Also, I think bleach would be a good cleaner IF it were thoroughly rinsed afterwards and allowed to airdry. However, my concern there is that if any residue were left and inhaled accidentally, it would be really harsh on the lungs. What about alcohol?? Anyone tried soaking them in alcohol? Would that be bad if inhaled??? Just some random thoughts...
 
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