Thursday, April 19, 2018

The Value of a 7% Saline Solution Treatment Via Nebulizer

This is a standard nebulizer set which is familiar to many.  Notice the mask attached to the nebulizer set. Such peripherals can only be used for one person.  You need a peripheral nebulizer kit for each person who is using the device.   Some are disposable, as in hospitals, and others are designed for boiling and reuse with the same patient for a period of time.

  Disclaimer:  The following post is informational and is designed to spur important conversations with you, and your physician or nurse practitioner. Families are encouraged to speak with their primary care provider before altering his/her orders where their family members are concerned, or instituting a new treatment without their physician's knowledge.

  If your child is having difficulty breathing, please call 911.

                       There are many types of family emergencies.  Some are of a more desperate nature, while others can be simply mammoth inconveniences.  If you were stuck at home with an adult or child, and you could not get out to a physician for a day or two, and your child began with a cold or flu which had large amounts of thick mucus, what would you do?     First, hydration is most important. The child or family member needs plenty of varied fluids. Pedialyte for small ones is a good idea if there is diarrhea or vomiting.  Gatorade (the standard formulation) would be beneficial to an older child.  Plain drinking water is underrated, and this is also a good idea.  Secondly, you wish to feed them moderately and contain a fever.   Many physicians leave a fever to burn out a viral syndrome, and they use Tylenol ( name used in the US, paracetamol in many other nations) ( also known as Acetaminophen) to treat a fever of 102 or greater.   I don't use Ibuprofen (Motrin in the US) on children without a direct physician's order to do so.
                        There is something else you can do that will help to break up thick secretions on both children and in adults.   Physicians usually order this treatment for children with cystic fibrosis, or for adults with COPD or other respiratory illnesses where excessive thick mucus is a problem.

                         An increasing number of families own a nebulizer. A nebulizer or nebulizer/compressor aerosolizes medication so that a child or adult can inhale it over a period of time.  EACH PERSON who uses the nebulizer needs their very own nebulizer set which attaches to the device with a long thin tube.
  It is important that such respiratory materials are not shared between family members who often do not have the same respiratory or oral organisms, especially in the presence of another chronic disease.

This is a Pari compressor/nebulizer.

                        When a physician orders a nebulizer device for a child or adult, he also orders a solution to be placed in the device for each treatment. Often these are bronchodilators which means they open the airways.  Drugs called Albuterol, and an analog of Albuterol which does not cause the increase in heart rate, is called Xopenex (the generic name is Levalbuterol).

                        Sometimes, following the bronchodilator as listed above, the physician will order another solution. Sometimes, such a solution will be a salt solution. Salt, in solution, when used in a nebulizer treatment can be a potent mucolytic, which means it can help to break up thick secretions. Salt does several things when used in a respiratory solution. First, it does act as a counter-irritant, and the patient does tend to cough, expelling mucus from areas he may not have prior. Secondly, a higher percentage of salt solution may make it more difficult for viruses and bacteria to replicate in the mucus lined regions of the lungs. For this reason, those with respiratory infections,may benefit from nebulizer treatments with salt solutions, two or three times a day, particularly during acute respiratory infections.

                   The amount of saline or salt in normal body fluids is 0.9%     Although there probably is some value in receiving a cool nebulizer treatment with 0.9% salt solutions, physicians often order a hypertonic saline solution. This means that the solution is stronger than the amount of saline found in normal body fluids.

                   In respiratory treatments, physicians have been known to order 3% saline solutions, but more often today, they are ordering 7% solutions for those with COPD (chronic obstructive pulmonary disease), bronchiectasis, and even as an adjunct in the treatment of cystic fibrosis. Some people with asthma who also have an concurrent infection have benefitted from such treatment when physician ordered.

                   When breathing nebulized fluids deep into your lungs, or the lungs of a family member, it is very important to ensure great cleanliness and often sterility of the articles used, including the fluids. When you open a medication that is pre-packaged, it has been presterilized. but when you make your own 7% saline, you must take great care to have everything sterile, otherwise you are introducing new organisms into the respiratory tree, which could be dangerous.

Making Your Own 7% Saline Solution for Nebulization:

You will need the following items. Please assemble them in advance.

1. Measuring spoons, washed in the dishwasher.
2. 5 cc syringes without needle.
3. A bottle of unopened distilled water
4. A polypropylene pharmacy grade bottle with the plastic code #5 on the bottom.    

      Do not use any other type of plastic as they may leach plastic ingredients into your solution. This bottle can be purchased from your pharmacy or through your physician.

5. A container of salt without additives.  (No iodine or other additives. NO Lite Salt, as that is partly potassium chloride)  Kosher salt, or pickling salt may be used. Some use plain sea sale successfully.

6. Medical Nebulizer with face mask or mouthpiece, tubing. (You need to have one of these for each patient in your family.) Some of these are designed for one time or several time use.  I would prefer you get a reuseable one that can be boiled for five minutes after each use.
(The best nebulizer on the market according to many pulmonologists is the Pari.  I like the Pari Vios Pro, because it delivers the solution very quickly and well and can run frequently with much less chance of overheating.)

7. Glass measuring cup calibrated in mls or ccs  (available at Wal-Mart's cooking section. Pyrex, clear glass with red writing.)   Wash it in dishwasher.

Directions:       Always wash your hands before any procedure.

1. Pour 250ccs (same as ml or milliliters) distilled water in your clean new #5 polypropylene bottle.

2. Add one level teaspoon of the salt described above to the bottle.  Gently shake.  These amounts will yield a 7 % solution.

3. Place in clean microwave with lid off for 15 seconds.  Allow to cool completely before use. Then recap when cool.

4. Use any ordered bronchodilators (albuterol etc.) via nebulizer first, before using 7% saline to help to avoid excessive coughing and bronchospasm.

5. When any pre-treatments are concluded, you may use four cc's as measured with your clean needleless syringe, and place it into your nebulizer bowl and start your nebulizer treatment.

When concluded,  prepare for your next treatment by:

Removing the lid from the 7% saline solution, and microwaving for 15 seconds, once again.  When cool, reapply lid.

Boiling your nebulizer peripherals (but not the tubing) for 5 minutes. Then place on clean paper towel to dry. When dry place in plastic zip lock bag until next use.

Store your reboiled cool solution in the refrigerator and replace it every three days.

Please follow directions exactly, as they improve your margin for safety.

Premade, sterile, pre-measured 7% saline is available via prescription from a physician.  If your physician orders it for you, this will save the procedure outlined in this post.  However, for some this is a continuous expense they cannot continue along with other medications they must have.    If you are out of it, and cannot replace it quickly enough, you have a procedure for making a 7% saline solution yourself.

           Inhaled 7% saline can be a very valuable strategy in the treatment of upper respiratory illness of varietal causes.

Other helpful posts on or related to this topic: