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Seeking detailed instructions for gentamicin instillation preparation

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    Seeking detailed instructions for gentamicin instillation preparation

    In another thread, I described how I cannot get pre-mixed gentamicin in saline solution for instillation any more due to a supply chain issue. Following up on a few posts on that thread, I am trying to figure out what exactly to request the urologist order so I can mix the gentamicin myself.

    My understanding here is that I would need:
    vials of gentamicin sulfate
    bottles of sterile saline solution
    a syringe for extracting the gentamicin sulfate and injecting it into the saline solution
    a catheter-tipped syringe for the instillation itself.

    I suppose I would buy a bunch of vials of gentamicin sulfate, then, each day, inject the contents of a vial into a bottle of saline solution.

    But I am unclear on the details of exactly what size bottles of the gentamicin sulfate and the saline solution; how to handle the syringe (I've never used a syringe, I do not know how to dispose of one either); and anything else.

    #2
    Ideally, you would consult a urologist familiar with the protocol, and your situation, and get official medical advice. But, essentially, your list of supplies is exactly what I use. I don't have the NDC code handy for the extraction syringes. They are small, ~3cc, I think, with what seems like a huge gauged needle. The saline bottles are normal 500ml. I attached an image of the gent vials that I get, you can see the NDC on it, for the specific product.

    I don't know how much of any of this is available without a prescription, either.

    I use one vial per 500ml, and use ~50cc each instillation, twice a day, ~12 hours apart, until it's gone.

    I used to do this once a month, but now I only do it when I start feeling symptomatic of a colony buildup. (Apparently I have some sensory sparring in parts of my bladder that allow me to sense when things aren't quite right.) Or when pee gets cloudy or stinky out of no where, etc.

    (I've only had 1 UTI in many, many years. And the last one occurred within a week of me posting that I hadn't had one in years, a few years ago. So, I'm pretty sure now I'm gonna get another one. )
    Attached Files
    "I have great faith in fools; ‘self-confidence’, my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    Comment


      #3
      The pre-mixed solution should be refrigerated. Decant as much as you need into a sterile cup (a specimen cup works well) at least 30 minutes before use to let it come to room temperature before instilling. Avoid using a bottle of solution which has had it's seal invaded (by a needle or access spout or lid) for more than 30 days.

      In most of the USA, the gent will require a prescription, and so will the syringes with needles (not the irrigation syringes).

      Syringes and needles should be disposed of in special needle boxes which you can obtain at any pharmacy. Do not put them into the regular trash! Many pharmacies and even hospitals have needle disposable boxes that look like a large mailbox that you can use to discard your personal needle boxes.

      (KLD)
      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

      Comment


        #4
        I buy my needles on Amazon it's like 15 or $20 for a case of 100. Sterile saline I get 100 ML bottles from my urological supplier and the same with the catheter tip syringes. Only use the catheter tip syringe once and then throw it away, my urologist does not believe in reusing anything.
        I think I mentioned this in your other thread but I get a 90 day supply from target CVS pharmacy it's very inexpensive my co-pay is 37.50 for 90 days of the gent
        Sales@rollinginparadise.com

        Comment


        • SCI-Nurse
          SCI-Nurse commented
          Editing a comment
          Don't you require a prescription for the syringes/needles and the gent? You would in my state (CA). (KLD)

        #5
        Originally posted by fuentejps View Post
        I buy my needles on Amazon it's like 15 or $20 for a case of 100. Sterile saline I get 100 ML bottles from my urological supplier and the same with the catheter tip syringes. Only use the catheter tip syringe once and then throw it away, my urologist does not believe in reusing anything.
        I think I mentioned this in your other thread but I get a 90 day supply from target CVS pharmacy it's very inexpensive my co-pay is 37.50 for 90 days of the gent
        no, I've always purchased them on Amazon it's just easier and cheaper no prescription needed.
        Sales@rollinginparadise.com

        Comment


          #6
          I’m curious to know the results of a urine culture from anyone whose does maintenance gentamicin instillations. Is your urine sterile or colonized?
          stephen@bike-on.com

          Comment


          • crispy1981
            crispy1981 commented
            Editing a comment
            Stephen, I think u chose to go the microcyn route instead of Gentamicin? I have been using microcyn for ~5 yrs now but thinking of trying Gentamicin because Microcyn can be a little rough on the bladder for me thus far. If i over-instill or over-use it i get AD just as bad as a bladder infection.

          #7
          Originally posted by stephen212 View Post
          I’m curious to know the results of a urine culture from anyone whose does maintenance gentamicin instillations. Is your urine sterile or colonized?
          im always sterile
          Sales@rollinginparadise.com

          Comment


            #8
            Gentamyacin is not a gentle antibiotic, for lack of a better word. It is harsh and is not without it’s issues.
            ckf
            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

            Comment


            • crispy1981
              crispy1981 commented
              Editing a comment
              ckf, if it were you would you use gentamicin or a different solution? I am in need of a solution to stave off bladder infections and was pondering Gentamicin.

            #9
            Gentamicin is antibiotic and as such, would be only effective against certain categories of bacteria, just like any other antibiotic. Would this be correct? If so, it would be possible to be colonized or infected with bacteria that are not sensitive to it.

            Comment


            • crispy1981
              crispy1981 commented
              Editing a comment
              My bacteria infections are typically not e-coli (eg. pseudomonas, Staphylococcus etc). A quick google search indicates ~50% of Staph bugs are resistant to Gent and Pseudomonas...so probably not a great idea for me to use it.
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