TOBI nebulizer

[Miriam57RN]

I have a homecare client, a baby on a vent, who was prescribed TOBI. When I came in, the Dad brought in a nebulizer piece (Pari LC Plus) that he said we're to use with it.

I understand that this particular chamber is a great chamber when it can be used with its mouthpiece as it has inspiratory and expiratory valves which increase efficiency and lessen medication waste... but I question whether it should be used through a vent circuit. From what he gave me, they're connecting it to the blue T-piece with a 6-in. piece of circuit tubing and some other T-piece which has an opening to air.

I think I should just use the regular neb chamber (the one used for xopenex or albuterol and pulmicort, for example) with the Tobi as there will be less/no leakage of medication into the air. I tried calling customer service, they won't be in until monday and I'm going back to this client tomorrow morning. This is the nebulizer in question: http://www.pari.com/pdd/jet-neb-tech.htm

Anyone familiar with it? Isn't it for mouth piece use only?

[caliotter3]

One of my home care clients was prescribed a med and pari nebulizer. I read all the literature that came with it as well as the notation in my med book that specifically said that med needed to be used with that particular nebulizer. I totally agree with you that it is being used improperly. Try to get the package insert from the med or the instruction manual from the pari neb, read it, and teach the family. Enlist the aid of your Respiratory Therapist if you need help with this. If the neb is not being used properly, then the patient is not getting the full benefit of the med and the nebulizer equipment. Good luck. You are very observant. Many people would say "heck with it" and go on doing it the old way.

P.S. My client was incapable of using the mouth piece so we improvised a way of plugging the holes on the tubing so he got the med as if he were inhaling it of his own accord.

[Miriam57RN]

I got it straight today as far as setting it up. There's a special green T-piece with an adapter used with the Pari (neb chamber) that goes in to the circuit in place of the blue T-piece that is used with the other nebs. It works and there are no gaps. The 6-in blue corrigated tubing connects the chamber to the green T on the circuit.

I called the equipment company's 800 number and spoke to someone. The Pari neb chamber must be used with the Tobi, because it breaks up the particles in a special way that the other kind does not, so it is used for vent cases as well as for those who can do mouth inhalation.

She's being treated for tracheitis, but the mother told me she was cultured for less organisms this time (at home) than during previous episodes during her year-long hospital stay, Yay! (premie born at 1 lb. 11 oz.). It sounds good to me that no psuedomonas or MRSA were cultured at home. They were found in the hospital cultures, and she's had PN there.

Doctor is giving her a 56-day course of the Tobi neb, which will be followed by 28-day off/ 28-day on periods for 6 months, to cover her over her first winter at home.

[caliotter3]

Miriam

Glad to hear that you've got everything all straight on the use of the nebulizer and that your little patient seems to be getting a good course of tx for her condition. I hope she does well with the tx and that she gets strong and thrives.