How to Mix Inhaled Medications

A diluted tobramycin solution is administered by nebulizer to help control the growth of Pseudomonas in the lungs of people with Cystic Fibrosis.

Equipment needed:

1. vials of Tobramycin 40 mg/mL
2. 10 mL vials OR 10 mL ampoules with no rubber top of 0.9% sodium chloride (also called “normal saline” or “saline”) or sterile water for injection
3. alcohol swabs
4. 5 mL syringes
5. 20 gauge needles

Procedure:

1. Wash your hands and make sure your work area is clean.
2. Remove the tops of the Tobramycin vials.
3. Use the alcohol swab to clean the rubber tops of the vials.
4. Attach the needle to the syringe.
5. Pull back air into the syringe.
6. The strength of Tobramycin in the vial is 40 mg/mL.
7. Insert the needle into the rubber top of the Tobramycin vial. Withdraw the required amount of Tobramycin: 80 mg = 2 mL and add it to your nebulizer cup.
8. Dilute the amount of Tobramycin with enough 0.9% sodium chloride or sterile water to give a total volume of 3 mL in your nebulizer cup. (You will need 1 mL)
9. Inhale the Tobramycin mixture by aerosol nebulizer over a period of about 20 minutes, according to the directions from your doctor.
10. Opened vials of Tobramycin are stable in the refrigerator for 7 days. Used 0.9% sodium chloride or sterile water vials can also be kept in the fridge but should be thrown away after 24 hours.
11. A new needle and syringe should be used each day to maintain sterility.

Your prescription for Tobramycin is:

Give 80 mg = 2 mL (+1 mL of 0.9% sodium chloride or sterile water) by nebulizer 2 times daily after physiotherapy.

A diluted Colistimethate (Colymycin®) solution is administered by nebulizer to help control the growth of Pseudomonas bacteria in the lungs of people with Cystic Fibrosis.

Equipment needed:

• vials of Colistimethate 150 mg
• 10 mL vials OR 10 mL ampoules with no rubber top of 0.9% sodium chloride (also called “normal saline” or “saline”) or sterile water
• alcohol swabs
• 5 mL syringes
• 20 gauge needles

Procedure:

1. Wash your hands and make sure your work area is clean.
2. Remove the tops of the Colistimethate and 0.9% sodium chloride vials or sterile water.
3. Use the alcohol swab to clean the rubber tops of the vials (if applicable).
4. Attach the needle to the syringe.
5. Pull back air into the syringe.
6. Insert the needle into the rubber top of the 0.9% sodium chloride or sterile water via (OR if using ampoules with no rubber top, insert needle into the opening of the ampoule without pulling back air).
7. Pick up the syringe needle & vial with one hand, making sure the needle is always below the liquid line.
8. Push the syringe plunger to release the air into the vial and pull back 3 mL of 0.9% sodium chloride or sterile water into the syringe.
9. Add the 3 mL of 0.9% sodium chloride or sterile water to the Colistimethate vial. Remove the syringe needle and recap the needle.
10. Gently swirl or roll the vial of Colistimethate in your hands until the powder has dissolved. Vigorous shaking will create a lot of foam. If foam develops just let the vial stand until it settles.
11. The strength of the Colistimethate in the vial is 50 mg/mL (150 mg in 3 mL).
12. Using the same technique as steps 5-8, withdraw the required amount of Colistimethate: 150 mg = 3 mL, and add it to your nebulizer cup.
13. Inhale the Colistimethate mixture by aerosol nebulizer over a period of about 20 minutes, according to the directions from your doctor.
14. Reconstituted vials of Colistimethate are stable in the refrigerator for 24 hours. Used 0.9% sodium chloride or sterile water vials can also be kept in the fridge but should be thrown away after 24 hours.
15. A new needle and syringe should be used each day to maintain sterility.

Your prescription for Colistimethate is:

Give 150 mg = 3 mL by nebulizer 2 times daily after physiotherapy

A diluted Amikacin solution is administered by nebulizer to help control the growth of Atypical Mycobacteria in the lungs of people with Cystic Fibrosis.

Equipment needed:

1. vials of Amikacin 250 mg/mL
2. 10 mL vials OR 10 mL ampoules with no rubber top of 0.9% sodium chloride (also called “normal saline” or “saline”) or sterile water
3. alcohol swabs
4. 5 mL syringes
5. 20 gauge needles

Procedure:

1. Wash your hands and make sure your work area is clean.
2. Remove the tops of the Amikacin and 0.9% sodium chloride or sterile water vials.
3. Use the alcohol swab to clean the rubber tops of the vials.
4. Attach the needle to the syringe.
5. Pull back air into the syringe.
6. The strength of Amikacin in the vial is 250 mg/mL.
7. Insert the needle into the rubber top of the Amikacin vial. Withdraw the required amount of Amikacin: 500 mg = 2 mL and add it to your nebulizer cup.
8. Dilute the amount of Amikacin with enough 0.9% sodium chloride or sterile water to give a total volume of 3 mL in your nebulizer cup. (You will need 1 mL)
9. Inhale the Amikacin mixture by aerosol nebulizer over a period of about 20 minutes, according to the directions from your doctor.
10. Opened vials of Amikacin are stable in the refrigerator for 7 days. Used 0.9% sodium chloride or sterile water vials can also be kept in the fridge but should be thrown away after 24 hours.
11. A new needle and syringe should be used each day to maintain sterility.

Your prescription for Amikacin is:

Give 500 mg = 2 mL (+1 mL of 0.9% sodium chloride or sterile water) by nebulizer twice daily after physiotherapy.

A diluted Ceftazidime solution is administered by nebulizer to help control the growth of Pseudomonas or Burkholderia cepacia bacteria in the lungs of people with Cystic Fibrosis.

Equipment needed:

1. vials of Ceftazidime 1 gram
2. 10 mL vials OR 10 mL ampoules with no rubber top of 0.9% sodium chloride (also called “normal saline” or “saline”) or sterile water
3. alcohol swabs
4. 5 mL syringes
5. 20 gauge needles

Procedure:

1. Wash your hands and make sure your work area is clean.
2. Remove the tops of the Ceftazidime and 0.9% sodium chloride or sterile water vials.
3. Use the alcohol swab to clean the rubber tops of the vials (if applicable).
4. Attach the needle to the syringe.
5. Pull back air into the syringe.
6. Insert the needle into the rubber top of the 0.9% sodium chloride or sterile water vial (OR if using ampoules with no rubber top, insert needle into the opening of the ampoule without pulling back air).
7. Pick up the syringe needle & vial with one hand, making sure the needle is always below the liquid line.
8. Push the syringe plunger to release the air into the vial and pull back 3 mL of 0.9% sodium chloride or sterile water into the syringe.
9. Add the 3 mL of 0.9% sodium chloride or sterile water to the Ceftazidime vial. Remove the syringe needle and recap the needle.
10. Gently swirl or roll the vial of Ceftazidime in your hands until the powder has dissolved. Vigorous shaking will create a lot of foam. If foam develops just let the vial stand until it settles.
11. Using the same technique as steps 5-8, withdraw the required amount of Ceftazidime: 1 gram = 3 mL, and add it to your nebulizer cup.
12. Inhale the Ceftazidime mixture by aerosol nebulizer over a period of about 20 minutes, according to the directions from your doctor.
13. Reconstituted vials of Ceftazidime are stable in the refrigerator for 24 hours. Used 0.9% sodium chloride or sterile water vials can also be kept in the fridge but should be thrown away after 24 hours.
14. A new needle and syringe should be used each day to maintain sterility.

Your prescription for Ceftazidime is:

Give 1 gram = 3 mL by nebulizer 2 times daily after physiotherapy