There are 2 ways to administer Pulmozyme (dornase alfa), with a Jet Nebulizer and Compressor or with a portable nebulizer like the eRapid™ Nebulizer System. For instructions using the portable eRapid™ Nebulizer System, go here
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Instructions for Use with Jet Nebulizers and Compressors
A nebulizer and a compressor are used together to give a dose of Pulmozyme (dornase alfa).
A nebulizer changes the Pulmozyme (dornase alfa) liquid medicine into a fine mist inhaled by breathing through a mouthpiece. A compressor gives the nebulizer power and makes the nebulizer work.
Pulmozyme (dornase alfa) should only be used with the approved nebulizers and compressors or with the eRapid® Nebulizer System.
Any other inhaled medicines should not be used in the nebulizer at the same time. Keep all other inhaled medication systems completely separate from Pulmozyme (dornase alfa).
A mask should not be used. The mouthpiece provided with each nebulizer kit should be used.
If a child cannot breathe in or breathe out by mouth, you may use the PARI BABY™ reusable nebulizer, but should first discuss it with a doctor. The PARI BABY™ nebulizer is the same as the PARI LC Plus Jet system, except the mouthpiece is replaced by a tight-fitting face mask connected to an elbow piece.
Steps to administer Pulmozyme using approved jet nebulizer systems
Supplies you will need to give a dose of Pulmozyme:
1 ampule of Pulmozyme
Compressor
Nebulizer cup and screw-on or snap-on cap
Plastic T connector (not needed for Sidestream nebulizer or PARI BABY™)
Flexible aerosol tube (not needed for Sidestream nebulizer or PARI BABY™)
Clean mouthpiece or PARI BABY™ facemask
Long connecting tube
Nose clip (optional, not needed for PARI BABY™)
Figure A
Remember to communicate these important instructions to patients/caregivers:
Step 1. Clean a flat table surface and wash your hands
- Clean a flat table surface
- Wash your hands well with soap and water before using the Pulmozyme (dornase alfa) ampule and nebulizer. This helps prevent infection (See Figure B)
Figure B
Step 2. Gather the nebulizer and test the compressor
- Place the nebulizer parts on a clean, flat table surface within reach
- Test the compressor by turning it on and putting your finger in front of the "air out" or "air" port to feel air flowing. Turn off the compressor (See Figure C)
- For the MOBILAIRE™ compressor only, turn the pressure control knob fully to the right for the highest pressure output
Figure C
Step 3. Gather the Pulmozyme (dornase alfa) ampule and check the expiration date
- Remove 1 foil pouch of Pulmozyme (dornase alfa) from the refrigerator. Open the foil pouch and remove 1 ampule of Pulmozyme (dornase alfa). Put the remaining ampules back in the foil pouch and return them to the refrigerator
- Check the expiration date printed on the ampule (See Figure D). Do not use the Pulmozyme (dornase alfa) ampule if the expiration date has passed
Figure D
Step 4. Check the Pulmozyme (dornase alfa) ampule
- Check the ampule for leaks by turning it upside down and gently squeezing (See Figure E). Do not use the ampule if it is leaking. Throw it away and get a new one
- Check the Pulmozyme (dornase alfa) liquid in the ampule and make sure it is clear and free of particles
- Do not use Pulmozyme (dornase alfa) if the liquid is cloudy or discolored. Take the Pulmozyme (dornase alfa) back to the pharmacy, hospital, or clinic that gave you the medicine
Figure E
Step 5. Attach the tube to the compressor
- Attach the long connecting tube to the "air out" or "air" port on the compressor (See Figure F)
Figure F
Step 6. Attach the mouthpiece.
- Skip to Step 7 if you use the Sidestream nebulizer or the PARI BABY™ nebulizer
- Push the mouthpiece into the wider end of the plastic T. Attach the flex tube to the other end of the T (See Figure G)
Figure G
Step 7. Remove the cap from the cup
- Unscrew or unsnap the cap from the nebulizer cup (See Figure H)
- Put the nebulizer cup on the table face up and place the cap upside down on a clean surface (See Figure I)
Figure H
Figure I
Step 8. Open the Pulmozyme (dornase alfa) ampule
- Hold the tab at the bottom of the Pulmozyme (dornase alfa) ampule firmly. Twist off the top. Do not squeeze the body of the ampule (See Figure J)
Figure J
Step 9. Pour the full Pulmozyme (dornase alfa) dose into the nebulizer
- Turn the ampule upside down and squeeze gently to empty the medicine into the nebulizer cup. Keep squeezing until the ampule is empty. It is very important you squeeze all of the medicine out of the ampule (See Figure K)
- Screw or snap the cap onto the nebulizer cup (See Figure L)
Figure K
Figure L
Step 10. Connect the plastic T
- Connect the plastic T to the nebulizer cap (See Figure M)
- If you are using the Sidestream nebulizer, attach the mouthpiece to the top of the nebulizer (See Figure N)
- If you are using the PARI BABY™ nebulizer, connect the elbow piece and mask to the nebulizer outlet (See Figure O)
Figure M
Figure N
Figure O
Step 11. Attach the tube to the cup
- Connect the open end of the long tube to the port on the bottom of the nebulizer cup by pushing up firmly (See Figure P)
Figure P
Step 12. Turn on the compressor
- Turn on the compressor and check to see that mist is coming out of the nebulizer (See Figure Q)
- If you are using the MOBILAIRETM compressor, turn the compressor control knob fully to the right, then turn on the compressor. The pressure gauge should move between 35 psi and 45 psi, the highest pressure output (See Figure R)
Figure Q
Figure R
Taking a dose of Pulmozyme with a nebulizer:
Step 13. Breathe through the mouthpiece.
- Skip to Step 14 if you are using the PARI BABY to give Pulmozyme (dornase alfa) to your child
- Place the mouthpiece between your teeth and on top of your tongue (See Figure S)
- Breathe slowly in and out through your mouth. Do not block the airflow with your tongue
- Do not breathe through your nose. If you have problems breathing only through your mouth, use a nose clip (See Figure T)
- Do not be concerned if liquid droplets form in the long connecting tube during treatment. When the nebulizer begins spitting, gently tap the nebulizer cup and continue breathing until the nebulizer cup is empty or stops making mist (See Figure U)
- If you need to stop treatment before you are finished, or you begin coughing, turn off the compressor and do not spill any of the medicine
- To start treatment again, turn on the compressor and continue breathing slowly in and out through your mouth
- The complete treatment usually takes from 10 to 15 minutes for most nebulizers and compressors
- If you are using the Sidestream nebulizer with the MOBILAIRE™ or Porta-Neb compressors, treatment usually takes from 2 to 6 minutes
- It is important to inhale the full dose of Pulmozyme (dornase alfa). If you find a leak or feel any moisture coming from the nebulizer during treatment, turn off the compressor and check to make sure the nebulizer cap is sealed correctly before continuing (See Figure V)
Figure S
Figure T
Figure U
Figure V
If you are using the PARI BABY™ nebulizer to give Pulmozyme to your child, follow the instructions below in Step 14. If not go to Step 15.
Step 14. Breathing through the facemask
During the treatment, your child may sit, lie down, or stand.
- Place the facemask gently but firmly over your child’s nose and mouth (See Figure W)
- Make sure there are no air gaps between the mask and your child's face. This will help make sure that your child will get the full dose of Pulmozyme (dornase alfa)
- It is important that you try to keep the body of the nebulizer upright during the entire treatment (See Figure W). The elbow piece will allow you to move the mask for a good fit while keeping the nebulizer body upright
- When the nebulizer begins "spitting," gently tap the nebulizer cup and continue treatment until the nebulizer is empty or stops making a mist (See Figure X)
- If you need to stop the treatment or your child begins to cough during treatment, turn the compressor off. Do not spill any Pulmozyme (dornase alfa)
- If you have not removed the mask and you want to begin the treatment again, turn on the compressor
- If you have removed the mask, repeat the steps above to replace the mask on your child’s face and restart the compressor
- The complete treatment usually takes from 10 to 15 minutes
It is important that your child inhale the full dose of Pulmozyme (dornase alfa). If you find a leak or feel moisture coming from the nebulizer during the treatment, turn off the compressor and make sure the nebulizer cap is sealed correctly before starting the compressor again (See Figure Y).
Figure W
Figure X
Figure Y
After your treatment with Pulmozyme:
Step 15. Prepare the nebulizer for cleaning and storage.
- Turn off the compressor and take apart the nebulizer system. Set aside the flex tube and the long connecting tube
Note: The Sidestream nebulizer does not use a flex tube - Throw away the Pulmozyme (dornase alfa) ampule in your household trash
- Follow the manufacturer's recommendations for care of your nebulizer and compressor
How should I store Pulmozyme?
- Store Pulmozyme (dornase alfa) in its foil pouch in the refrigerator between 36°F to 46°F (2°C to 8°C) until you are ready to use it
- When traveling, Pulmozyme (dornase alfa) should be kept cold
- Do not freeze Pulmozyme (dornase alfa)
- Protect Pulmozyme (dornase alfa) from excessive heat and strong light
- Do not use Pulmozyme (dornase alfa) if it has been left at room temperature for a total time of 24 hours or if it becomes cloudy or discolored
- Do not use Pulmozyme (dornase alfa) past the expiration date printed on the ampule