Omnipaque shortage

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Crybaby

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Anyone with any insight to this? Expected shortages 6-8 weeks. My affiliated hospitals are cancelling elective imaging with contrast.
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It's too bad a 50ml vial costs me significantly less than the 10ml one. I use probably less than 1ml of that 50ml vial and am forced to discard the rest. I wonder if aliquoting is the answer for now.
 
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Yes - we aliquot from larger vial in past when shortage was very severe.

Also switched to 240 from 300 (all we could get) from time to time and have no appreciable difference in contrast/image quality.
 
No issues here.

Recommend breaking CDC guidance and re-using single dose vial for multiple patients.
If only 1 doc with access, 1 needle, 1 syringe, sterile swab- no re-entry using same needle or syringe.
Discussed at length in old thread.
 
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just got an email about it in our system (east)
 
we have issues as well.

i dont see how we can start multi-using the vials now. either it is safe or it isnt -- the shortage shouldnt push it one way or another. contrast is expensive and if we could have been multi-using in the past then we should have been. my impression is that the CDC is pretty clear on this
 
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System is taking all of our supply to give to the hospital for radiologic studies.
 
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Id think that cards, vascular, neurointerventional stuff will take precedence.

This is a big deal if it doesnt get resolved.

Time to go without contrast for mbbs? Possibly also for hips, shoulders, and SIJ
 
Many practices have little choice but to use the same vial for multiple patients. I suppose the choice is to cancel procedures. The harm in that case is greater, IMO.

In the days before the northwest compounding contamination issue, we re-used contrast vials all day in the surgery center. Never an issue.

What is your protocol for using the same vial multiple times?
 
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We use isovue m200 at the hospital after using Omni 300 for years. Can’t remember if it was too expensive or not available. Omni 240 in the office.
 
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Ligament said:
Many practices have little choice but to use the same vial for multiple patients. I suppose the choice is to cancel procedures. The harm in that case is greater, IMO.

In the days before the northwest compounding contamination issue, we re-used contrast vials all day in the surgery center. Never an issue.

What is your protocol for using the same vial multiple times?
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1) Entry into bottle with ONLY a new 18G and new syringe.
2) Alcohol wipe before any repeat entry.
 
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Those doing multi dose: how many days is a bottle good for after being punctured?
 
SSdoc33 said:
we have issues as well.

i dont see how we can start multi-using the vials now. either it is safe or it isnt -- the shortage shouldnt push it one way or another. contrast is expensive and if we could have been multi-using in the past then we should have been. my impression is that the CDC is pretty clear on this
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Care to explain the science?
 
lobelsteve said:
Care to explain the science?
Click to expand...
id love to be able to re-use the bottles.

and no, I cant explain the science.

the thought process is that we (injectionists) arent smart enough to remember to charge the needle and string every time we enter an omnipaque bottle. my guess is that the CDC policy actually does probably prevent some contamination, but it is based on eliminating human error
 
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I use multi use vials; I will continue to use multi use vials.

New 18g, new syringe, alcohol wipes after every puncture of the rubber stopper.

My practice is many thousands of injxns with multi use vials and there's never been one issue.

Don't @ me.
 
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Why would there ever be an opportunity to use an old needle?

We open a new pack that has a plethora of new needles and syringes every case and discard the entire pack after every case. Why would anyone practice differently than that? I use multi dose products routinely and will continue to do so.
 
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BobBarker said:
Why would there ever be an opportunity to use an old needle?

We open a new pack that has a plethora of new needles and syringes every case and discard the entire pack after every case. Why would anyone practice differently than that? I use multi dose products routinely and will continue to do so.
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I only drop a single 18g/case. Use it to draw up all meds and as a pointer.
 
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SSdoc33 said:
I only drop a single 18g/case. Use it to draw up all meds and as a pointer.
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A new 18g per case right?

So, take that needle and draw meds. Then use it as a pointer. When case is finished throw it away right?
 
MitchLevi said:
A new 18g per case right?

So, take that needle and draw meds. Then use it as a pointer. When case is finished throw it away right?
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Yes. But if i need more contrast (which is rare) id need to drop another 18g and syringe. Not a big deal.

I dont have a problem with using multidose vials and have advocated for it extensively. Administrators with lots of initials after their names feel otherwise
 
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SSdoc33 said:
Yes. But if i need more contrast (which is rare) id need to drop another 18g and syringe. Not a big deal.

I dont have a problem with using multidose vials and have advocated for it extensively. Administrators with lots of initials after their names feel otherwise
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They will never know. If you ever need more meds in a case, get a new needle dropped and place old one used as pointer in sharps container first.
Also get new syringe in this situation.
 
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Is anyone else having their supply of omnipaque removed and given to the hospital yet?
 
Push comes to shove - No contrast, use dex and a lido test dose (I never do these).
 
cant do a TFESI without contrast.

are you con check CrCl on everyone wh get gad? only over 65?
 
I think it's safer to do TFESI without contrast than with gad
 
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Not that this is 100% the correct thing to do, but our RN will draw the omnipaque into a large syringe at the beginning of the day, then will squirt out a little into our procedure tray each case. No reentering a vial and there is no touching of the needle tip. End of day the syringe is discarded.
 
Ferrismonk said:
Not that this is 100% the correct thing to do, but our RN will draw the omnipaque into a large syringe at the beginning of the day, then will squirt out a little into our procedure tray each case. No reentering a vial and there is no touching of the needle tip. End of day the syringe is discarded.
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How long till it crystallizes? I thought it was quick
 
From the LCD:

"The ESIs must be performed under computed tomography (CT) or fluoroscopy image guidance with contrast unless the patient has a documented contrast allergy or pregnancy where ultrasound guidance without contrast may be considered"
 
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Ferrismonk said:
Not that this is 100% the correct thing to do, but our RN will draw the omnipaque into a large syringe at the beginning of the day, then will squirt out a little into our procedure tray each case. No reentering a vial and there is no touching of the needle tip. End of day the syringe is discarded.
Click to expand...
This sounds way worse than tapping a single vial repeatedly. Once syringe being used all day is not a rubber stopper vial.
 
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lobelsteve said:
This sounds way worse than tapping a single vial repeatedly. Once syringe being used all day is not a rubber stopper vial.
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I disagree. The act of wiping the top and puncturing has the potential to cause contamination, I think drawing the whole thing as mentioned above is a good alternative.
 
I've done/seen all of the above before at various facilities without issues, but I like this way the best. I think it's a nice compromise between keeping it a closed system and not contaminating the stopper with your thumb/multiple pokes:

Setup mayo stand with sterile drape.
Drop 25 3 mL syringes, 25 luer caps, an 18 ga drawing needle hooked up to extension tubing.
Glove up, have someone hold bottle upside down.
Stick in 18 ga, draw up 2 mL in each syringe from the extension tubing, cap, return to mayo. Minimal exposure to air.
Squirt one syringe into tray each procedure.

I keep a poked bottle overnight, since only one poke, but do have some anxiety about it.

If you think about all the SCS trials, especially the 30 day ones they did in Europe, labor epidurals, sketchy pain practices, and the relative low incidence of infection, I think the epidural space is not as sensitive to infection as we treat it, but good to be overly cautious about it.
 
I'm definitely not going to throw out bottle in between cases. We know how the CDC overreaches when their science is lacking....masks, (cough)

Would never use gad not worth the risk. Would not use contrast for all cases and save just for CESI if things got really bad.
 
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dipriMAN said:
I disagree. The act of wiping the top and puncturing has the potential to cause contamination, I think drawing the whole thing as mentioned above is a good alternative.
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Your logic is flawed.

If what you say is true, we would have many more infections because this is what we do for every single draw from a bottle.
 
Not sure why this is really being discussed TBH.

Despite all the different ways to clean and prep and draw meds, raise your hand if you've caused an infxn with an ESI...

Also, clean the stopper before and after each draw from the vial. We use multidose contrast, steroid, local and saline. So right there I'm apparently brazenly and wildly throwing caution to the wind and exposing my pts to severe risk on every injxn.
 
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Ferrismonk said:
Not that this is 100% the correct thing to do, but our RN will draw the omnipaque into a large syringe at the beginning of the day, then will squirt out a little into our procedure tray each case. No reentering a vial and there is no touching of the needle tip. End of day the syringe is discarded.
Click to expand...
reading the CDC info, i think this is less recommended than drawing from the same vial multiple times. the contrast sits in the large syringe to fester...

CDC does leave an "out":
CDC recognizes the problem of drug shortages; however, such shortages are a result of manufacturing, shipping, and other issues unrelated to the above guidelines (http://www.fda.gov/DrugShortageReport ). CDC ’s priority is protecting patients from harm. CDC routinely investigates and is apprised of infectious disease outbreaks involving single-dose/single-use vials being used for multiple patients. These outbreaks cause extensive harm to patients, and they are associated with significant healthcare and legal expenses. Therefore, CDC continues to strongly support its current policies regarding single-dose/single-use vials. It is imperative that drug shortages and drug waste concerns are dealt with appropriately and do not lead to unsafe medical practices that impose increased disease risk on patients. Shortages of some essential medications may warrant implementation of meticulously applied practice and quality standards to subdivide contents of singledose/single-use vials, as stated in United States Pharmacopeia General Chapter <797> Pharmaceutical Compounding – Sterile Preparations.
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later down, in a "statement: response graph":
According to CDC, there is never a circumstance when contents from a single-dose/single-use vial may be used for more than one patient.

CDC recommends that providers limit the sharing of medications whenever possible. Qualified healthcare personnel may repackage medication from a previously unopened single-dose/single-use vial into multiple single-use vehicles (e.g., syringes). This should only be performed under ISO Class 5 conditions in accordance with standards in the United States Pharmacopeia General Chapter 797, Pharmaceutical Compounding – Sterile Preparations, as well as the manufacturer’s recommendations pertaining to safe storage of that medication outside of its original container
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also, per JCAHO, multi use vials are good for 28 days from date of puncture or until end of month when it is supposed to expire, whichever comes first.

Multi-dose Vials - Managing Multi-dose Vials of Injectable Medication | Home Care | Medication Management MM

What are the Joint Commission's expectations for managing multi-dose vials of sterile, injectable medication ?
www.jointcommission.org www.jointcommission.org



for your information:
 
Singledose/single-use vials are not multi-use vials unless I'm wrong...
 
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MitchLevi said:
Not sure why this is really being discussed TBH.

Despite all the different ways to clean and prep and draw meds, raise your hand if you've caused an infxn with an ESI...

Also, clean the stopper before and after each draw from the vial. We use multidose contrast, steroid, local and saline. So right there I'm apparently brazenly and wildly throwing caution to the wind and exposing my pts to severe risk on every injxn.
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I have 3 infections over my career. 1 SCS in RA patient. 1 ESI in RA patient. 1 SCS in a guy who went in ocean POD2.
All treated with IV ABX and explant. Reimplanted the RA patient after 6 mo and cleared by ID. 5+ years ago.
No deficits in any patient.
 
lobelsteve said:
I have 3 infections over my career. 1 SCS in RA patient. 1 ESI in RA patient. 1 SCS in a guy who went in ocean POD2.
All treated with IV ABX and explant. Reimplanted the RA patient after 6 mo and cleared by ID. 5+ years ago.
No deficits in any patient.
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Right, so you've got pts with immune dz. Don't use the needle after it falls on the floor.
 
only infection ive had is a pretty dirty guy who had a pilonidal cyst after a ganglion impar block. i think the cyst was there the whole time, anyway, but cant prove it. that was 10 years and probably 20K injections ago
 
buddababa said:
mmhm, no issues here (midwest)
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It might be a matter of time. If it was available where I lived, I would probably buy as much as possible right now anticipating that shortages will probably get a lot worse before they get better.

Lidocaine - gone
PFNS - gone
contrast - gone

Are needles next? LOL!
 
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