Kristin Shelton, CPFT, RRTKristin Shelton, CPFT, RRT

Cystic Fibrosis CenterCystic Fibrosis Center

Lucille Packard Children’s Hospital at StanfordLucille Packard Children’s Hospital at Stanford

Cleaning Equipment 101Cleaning Equipment 101CF Education Day 2009CF Education Day 2009

Cleaning Your Respiratory Cleaning Your Respiratory EquipmentEquipment

Germs can get on respiratory equipment and cause lung infections.

It is important to clean and disinfect equipment that has been in contact with mucous membranes, or secretions.

Clean and disinfect all equipment used for inhaled medicines or airway clearance using the manufacturer’s instructions.

To clean and disinfect your nebulizer, follow these steps:

Clean your hands.1

Disassembled nebulizerDisassembled nebulizer

Disassembled nebulizerDisassembled nebulizer

Disassembled nebulizerDisassembled nebulizer

Clean and rinse the nebulizer parts. 2

Disinfect nebulizer parts using one of Disinfect nebulizer parts using one of

these options:these options:33

Boiling for 5 minutes

Dishwasher, if the water is hotter than 158° F for 30 minutes

The CFF has approved the electric The CFF has approved the electric Avent iQ24 steam sterilizer as an Avent iQ24 steam sterilizer as an

option for disinfection.option for disinfection.

Soaking in a solution of 1 part household bleach and 50 parts water

for 3 minutes

+

1 Part 50 Parts

4. Rinse the nebulizer parts.If you disinfect using bleach, rinse all parts thoroughly using sterile water. You can make water sterile by boiling it for 5 minutes.

5. Air-dry the nebulizer parts.Drain the parts on a clean surface covered with new paper towels. Remember, germs will grow on anything that stays wet, so store the dry nebulizer in a clean, dry bag in a clean, dry place.

Maintaining your Maintaining your compressorcompressor

Remember to change your filter every 6 months

Which nebulizer for which Which nebulizer for which drug?drug?

Pari LC Plus:Pari LC Plus:

TobiTobi Colistin (Colistimethate, Colistin (Colistimethate,

Colymycin)Colymycin) Albuterol Albuterol Hypertonic Saline (Hyper-Hypertonic Saline (Hyper-

sal)sal) Pulmozyme (Dornase Pulmozyme (Dornase

Alpha)Alpha) Mucomyst (Acetylcystine)Mucomyst (Acetylcystine) Pulmocort Respules Pulmocort Respules

(Budesonide)(Budesonide)

Which Nebulizer for which Which Nebulizer for which drugdrug

Pari Sprint:

Use with Albuterol Hypertonic Saline Mucomyst (Acetylcystine) Pulmozyme (Dornase

Alfa) Pulmicort Respules

*Replace every six months

Which nebulizer for which Which nebulizer for which drug?drug?

Pari LC StarPari LC Star

Colistin Colistin (Colistimethate, (Colistimethate, Colymycin)Colymycin)

Which nebulizer for which Which nebulizer for which drug?drug?

Side Stream nebulizer:

Use with Pulmozyme (Dornase Alfa) or

Albuterol

Replace once a year

Which nebulizer for which Which nebulizer for which drug?drug?

E-flow nebulizer:

Use with Colistin (Colistimethate sodium),

Hypertonic saline

Replace aerosol head every ninety days

Which nebulizer for which Which nebulizer for which drug?drug?

Disposable nebulizer:

use if you have no other nebulizer available.

Replace each month

Nebulizing for a child Nebulizing for a child

The bubble’s the fish mask will melt if boiled.

Nebulizing for an infantNebulizing for an infant

Recommended order of Recommended order of nebulized medicationsnebulized medications

1.1. Bronchodilators: (Albuterol, Xopenex, Atrovent, Bronchodilators: (Albuterol, Xopenex, Atrovent, Combivent) to open the airways.Combivent) to open the airways.

2.2. Mucomyst: (10%) (20%) to break up mucous.Mucomyst: (10%) (20%) to break up mucous.3.3. Hypertonic Saline: (7%) (available now in Hypertonic Saline: (7%) (available now in

premixed vial manufactured by Pari called premixed vial manufactured by Pari called Hypersal) to mobilize mucus and improve airway Hypersal) to mobilize mucus and improve airway clearance.clearance.

4.4. Pulmozyme: (Dornase Alfa) to thin mucus.Pulmozyme: (Dornase Alfa) to thin mucus.5.5. Airway ClearanceAirway Clearance6.6. Antibiotics: (TOBI, Colistin) the previous therapies Antibiotics: (TOBI, Colistin) the previous therapies

open and clear the airways thereby improving the open and clear the airways thereby improving the distribution and effect of these antibiotics.distribution and effect of these antibiotics.

7.7. Steroids: (Flovent, Pulmicort, QVAR, Symbicort, Steroids: (Flovent, Pulmicort, QVAR, Symbicort, Advair) to relieve inflammation.Advair) to relieve inflammation.

Special ConsiderationsSpecial Considerations Do not mix medications in the same nebulizer unless proven to be Do not mix medications in the same nebulizer unless proven to be

compatible.compatible.

Use a mouthpiece whenever possible (moving the mask just 2 cm Use a mouthpiece whenever possible (moving the mask just 2 cm away from the face may reduce the delivery of nebulized drug by away from the face may reduce the delivery of nebulized drug by up to 85%; in addition, nasal deposition further reduces airway up to 85%; in addition, nasal deposition further reduces airway deposition).deposition).

Learn how each medication should be stored (e.g., refrigerator, Learn how each medication should be stored (e.g., refrigerator, room temperature, travel considerations) and any special mixing room temperature, travel considerations) and any special mixing concerns.concerns.

Be aware of possible side effects for each medication (e.g., Be aware of possible side effects for each medication (e.g., bronchospasm, hoarseness/voice changes, increased cough and/or bronchospasm, hoarseness/voice changes, increased cough and/or secretions, sore throat, loss of taste or hearing).secretions, sore throat, loss of taste or hearing).