How can I nebulize 4 drugs in each session?

I'm no expert because I'm still fairly new on this journey. I'm same as you plus apergillus and micobacterium abscessus. I have a PICC line in the chest and am infusing Tigecycline and Amikacin at home (they are still adjusting the Amikacin because I went off the charts after the first infusions). Nebulize last whatever you want to stay with your lungs. Albuterol/DuoNeb is always first to relax the airways. After that I add my SmartVest and do either saline or NAC. That was followed with budesonide and toby. I just completed my first 28 days of toby and am off of it for 28 days. My throat celebrates every day!!!!
A game changer for me was the nebulized NAC which I got about a week ago. I was filling up with congestion during the night enough that it would wake me up.....I would climb out of bed (2:00am/ 3:00am) and go nebulizing trying to clear all the crap (my ID calls it crap, so it is a medical term). Since nebbing NAC...no more congestion building up during the night.
I have never been told about allowing any time between different medications. Someone else here may have more info on that. I've been doing one right after the other. The bigee is to save for last whatever you want to stay with your lungs the longest.
Have a Blessed Day!!!

Thank you for the response and really good advise!
I nebulize Toby last and start with the Albuterol/7% saline and at the same time I use my vest. I just started with NAC and that's what prompted my question. I think from what you said I will take the NAC next to last. My question came because I read about needing to know what medications are compatible and can be taken right after each other. This internet article said that Toby needs to be taken 90 minutes after everything else. I thought that could not be true and if so what else needs to be taken with time separation. Maybe I am making a mistake about taking the mediations one right after another.

I also thought I would never speak again or have a calm throat. I found honey in particular Manuka Honey. After nebulizing Toby I immediately take a spoonful of honey and let it melt slowly in my mouth as I before swallow. It has made a world of difference.

Many thanks and have a good holiday!

I was told by my Pulmonologist to wait at least 30 minutes between my Albuterol/Saline (Smart Vest) and Tobramycin nebulizer treatments. That this would help greatly with the side effects I was having ( excessive coughing which seemed to bring the medication back up out of the lungs, dry mouth, very sore throat, hoarseness). This has helped me and I'm almost done with my first 28/30 days of the regiment. I've tried oral antibiotics and also a picc line and nothing has been able to take care of the Pseudomonas due to my Bronchiectasis.

Are the Toby inhalations helping? Which IV antibiotic did they try and for how long? Oral was Cipro?

Don't think you're supposed to, although I was in the hospital in 2020 and they were jammed up with covid patients. (Not me) The respiratory therapists were so over worked and overwhelmed they put all 3 in each treatment I got. It didn't help me or them because it still took forever to do it and also it foamed up so bad.

I always mix the albuterol and saline because in the old days they were always mixed. I am supposed to use pulmozyme also but I don't feel like it does much good. I then use tobi one month and cayston the next month, alternating. It's a chore but it's what we need to do! We are all in this together!

I don't mix any of the drugs but I do the Albuterol and Saline right after each other and then wait 30+ minutes to begin nebulizing the Tobramycin.

I was oral Ciprofloxacin (twice) and IV Meropenem before adding the Tobramycin. The last time I did the Cipro for 14 days orally and I'm now done with my 1st month of Tobi and my sputum sample was all clear of pseudomonas. I worry about the month I'm not on anything and how my Bronchiectasis will effect it, though.

What do you feel "cleared" the pseudo? The Toby? Did the Meropenem help for any length of time or did you do the Toby right after it?

My sputum culture is showing No growth of organisms, when in the past 6 months there has been pseudomonas. The picc line 21 day ( plus 4 days in hospital ) of Meropenem helped, but only for about 3 weeks before I had fevers and my sputum sample showed moderate growth of pseudomonas plus others. This when my Pulmonologist (plus ID specialist) put me on a course of Cipro for 14 days (oral) and I started on Toby. So far the Toby is working wonders. My everyday coughing is way, way down since the pseudomonas is no longer present and I feel much better.
Good luck!