Caregiver Guidelines (revised May 15, 2006)
Currently, 7% hypertonic saline solution for inhalation is not commercially available. Compared with commercially prepared saline solutions compounded hypertonic saline solution has a relatively short shelf life, so the CF Services Pharmacy has decided not to offer a compounded version of this product. Instead, the CF Foundation and the CF Services Pharmacy recommend preparing 7% hypertonic saline solution for inhalation by mixing commercially available 0.9% and 10% saline solutions at the time of use.
As of May 15, 2006, the CF Services Pharmacy will accept prescriptions for patients to prepare their own 7% hypertonic saline solution by mixing commercially manufactured 0.9% and 10% solutions. Orders dispensed from the CF Services Pharmacy will include the CF Foundation's FAQ on hypertonic saline (available on Port CF) and will also include a patient version of the guidelines (available on Port CF) based on the Australian clinical trial.
Summary of the Australian clinical trial:
- Maintenance hypertonic saline treatment was not studied in patients with severe obstructive lung disease (FEV1 < 40% predicted).
- Hypertonic saline was not substituted for other proven therapies.
- The first administration of hypertonic saline was done under observation in a clinical setting.
- Pre and post spirometry was done with the first dose.
- A bronchodilator was used (fast-acting agent via inhaler or nebulizer) 15-60 minutes before the hypertonic nebulized therapy.
- Aerosol therapies were administered in the following order:
- bronchodilator
- hypertonic saline
- airway clearance
- DNase
- corticosteroids
- antibiotics
- Hypertonic saline solution should be used with a PARI LC PLUSŪ jet nebulizer and a PARI PRONEBŪ Turbo compressor.
- Hypertonic saline solution was not mixed/nebulized with other medications.
- 4 mL of 7% hypertonic saline was administered twice daily.
- Hypertonic saline solution did induce coughing. Side effects also included sore throat and chest tightness.
Directions for preparing a 4 mL 7% saline solution:
- The vials of 0.9% and 10% saline solution provided in the 7% hypertonic saline "kit" from the CF Services Pharmacy are for single-use only. There are no preservatives in these single-use vials, so patients should use the amount indicated for one dose and dispose of the remaining mixture and the open vials of unused saline solution.
- Good sanitary technique should be used when preparing the 7% hypertonic saline solution. Individuals should wash their hands and create a clean working area to prepare the mixture.
- The 10 mL graduated cylinder provided by the CF Services Pharmacy to use when preparing the 7% hypertonic saline solution should be carefully cleaned after each use in the same manner as the nebulizer cup.
- A 7% hypertonic saline solution is prepared by mixing 3 mL of 0.9% saline solution and 6 mL of 10% saline solution in the graduated cylinder. 4 mL of this mixture, or the amount prescribed by the treating physician, should be poured into the nebulizer cup. The remaining 7% saline mixture and any open vials unused saline solution should be discarded.
Prescriptions should be written as follows (separate prescription is needed for each item):
- 0.9% hypertonic saline; quantity = 60 vials (3 mL/vial, total 180 mL)
- 10% hypertonic saline; quantity = 60 vials (15 mL/vial, total 900 mL)
- Days supply: 30
- Instructions: Add 3 mL of 0.9% saline solution to 6 mL of 10% saline solution. Nebulize 4 mL of this mixture twice daily.
Prescriptions can be called or faxed in to the CF Services Pharmacy and must include a patient name and phone number. Orders dispensed by the CF Services Pharmacy will include the CF Foundation's FAQ on hypertonic saline and a patient version of the self-preparation guidelines listed above.
CF Services Colorado: (800) 438-4301 - phone, (800) 233-3504 - fax
CF Services Texas: (866) 574-1414 - phone, (866) 574-1418 - fax
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