Omnipaque shortage

[Pain Applicant1]

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 think you're right. With SDV, you're not supposed to tap them more than one time. Drawing up and aliquoting into one syringe which is then used to inject into multiple syringes throughout the day seems to be the most reasonable. I'm going to set up all contrast-based procedures for the week in one day and then consider doing this. Then discard it at the end of the day.

Of course, I know nothing about this.

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[Pain Applicant1]

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.

Don't forget about the contaminated vials from that New England pharmacy. Plenty of pts received them but only a small percentage suffered complications.

 

[bedrock]

What about multi-dose vials of depomedrol?

I’ve always understood that multi-dose vials contained more preservative which is potentially more neurotoxic, which is why they are ok for joints, but not for ESI.

Are some people using mulit-dose vials of steroid for ESI? Any issues?

Much easier to find multi-dose vs single dose vials of depomedrol right now.

 

[SSdoc33]

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!

yes. having trouble finding 22g 3.5 from one of our suppliers

 

[Pain Applicant1]

yes. having trouble finding 22g 3.5 from one of our suppliers

I was joking and I hope you are too but I'm afraid you aren't. Thanks for the heads up, I'm going to start stacking up starting now.....

I'm looking forward to seeing the recommendations on how to work around this one.

 

[lobelsteve]

What about multi-dose vials of depomedrol?

I’ve always understood that multi-dose vials contained more preservative which is potentially more neurotoxic, which is why they are ok for joints, but not for ESI.

Are some people using mulit-dose vials of steroid for ESI? Any issues?

Much easier to find multi-dose vs single dose vials of depomedrol right now.

If IT, do not inject. If epidural, ok to inject.
SIS fact finder on topic.

 

[Pain Applicant1]

yes. having trouble finding 22g 3.5 from one of our suppliers

Who do you use? I mainly use Henry Schein.

I pay about $5 for 50ml omnipaque 240.
22g 3.5 spinal - $2.37
20g 3.5 touhy - $7.77

Things have really increased in price.

Chloraprep clear is also unavailable. I just racked up on the orange tint.

 

[SSdoc33]

Who do you use? I mainly use Henry Schein.

I pay about $5 for 50ml omnipaque 240.
22g 3.5 spinal - $2.37
20g 3.5 touhy - $7.77

Things have really increased in price.

Chloraprep clear is also unavailable. I just racked up on the orange tint.

im a step or 2 removed from the procurement process

 

[MitchLevi]

What about multi-dose vials of depomedrol?

I’ve always understood that multi-dose vials contained more preservative which is potentially more neurotoxic, which is why they are ok for joints, but not for ESI.

Are some people using mulit-dose vials of steroid for ESI? Any issues?

Much easier to find multi-dose vs single dose vials of depomedrol right now.

I use multidose Depo, Kenalog, Beta, contrast and saline.

 

[buddababa]

yes. having trouble finding 22g 3.5 from one of our suppliers

Same. Frustrating.

 

[Ducttape]

actually... was told there was some limitations to 22 ga 3.5 inch needles.


was asked if i prefer the available 22 ga 3 inch or 22 ga 5 inch. then she laughed and wondered what she was even thinking, and ordered more 22 ga 7 inch needles.

 

[DOctorJay]

Switching to gad

just wanted to clarify this is what was suggested, I'm not doing neuraxial with gad

 

[Taus]

Anyone with a status update or suggestion on this? My ASC is going to run out in about a week without clear prospects… No Bueno.

 

[Agast]

per my ASC which is super strict on rules:

“We can use them as a multi dose as long as it is drawn up and labeled before any patients are in the room”

I’m going to clarify whether they mean the entire bottle needs to be aliquoted into individual syringes before the first patient of the day, I’ve seen that before.

 

[Agast]

Apparently we are rolling in riches of contrast so I’m glad I’m pumping the breaks now before the tears start

 

[drusso]

Who do you use? I mainly use Henry Schein.

I pay about $5 for 50ml omnipaque 240.
22g 3.5 spinal - $2.37
20g 3.5 touhy - $7.77

Things have really increased in price.

Chloraprep clear is also unavailable. I just racked up on the orange tint.

You can try to negotiate better prices with your account rep.

 

[BobBarker]

You can get a kit with a 20g Tuohy and LOR with syringes, drape, draw needles for between $10 and $14. Spinal needles can be had for between $1-2 if you are ok with not using BD.

 

[vadim1980]

I use 23g 3.5 inch spinals. Steer like the 22g but possibly less discomfort for patient

 

[BobBarker]

23g are great. I bought a bunch of BD 23g 3.5” for around $2.10 each.

 

[clubdeac]

Why's everyone so skittish about neuraxial gad? Worried about nephrogenic systemic fibrosis in renal failure patients or the neurotoxicity if intrathecal? My understanding from review of the literature is that most complications occurred when > 3 cc's were used and injected intrathecally. A cc even if IT shouldn't be dangerous. I started using this with contrast allergy patients but am extremely careful and use no more than 1cc

Also we have run out of all sorts of supplies over the last few months. Had to use labor epidural trays, then para trays, then central line trays. It's been horrific. And now today we ran out of touhys. Actually had to cancel my first case today, CESI

 

[callmeanesthesia]

Why's everyone so skittish about neuraxial gad? Worried about nephrogenic systemic fibrosis in renal failure patients or the neurotoxicity if intrathecal? My understanding from review of the literature is that most complications occurred when > 3 cc's were used and injected intrathecally. A cc even if IT shouldn't be dangerous. I started using this with contrast allergy patients but am extremely careful and use no more than 1cc

Also we have run out of all sorts of supplies over the last few months. Had to use labor epidural trays, then para trays, then central line trays. It's been horrific. And now today we ran out of touhys. Actually had to cancel my first case today, CESI

Should have used Lobel’s 25g spinal needle technique.

Do any private practice docs use the pre-made trays? I use separately dropped supplies due to cost but I’m looking for ways to increase procedure speed. Not sure if it would pencil out in time saved vs cost but I figure 1 extra procedures a day would cover the cost of the trays (about 25 procedures/day).

 

[RoloTomassi]

Should have used Lobel’s 25g spinal needle technique.

Do any private practice docs use the pre-made trays? I use separately dropped supplies due to cost but I’m looking for ways to increase procedure speed. Not sure if it would pencil out in time saved vs cost but I figure 1 extra procedures a day would cover the cost of the trays (about 25 procedures/day).

Used to use trays, then went to dropping to save money, which is pretty significant. The ~$10 savings x2000/year adds up. I drop, write note, then do one-hand draw while room is being turned over, so none of that opportunity cost.

 

[Pain Applicant1]

You can try to negotiate better prices with your account rep.

Coincidentally, I have a phone meeting with her today. She called last week for some reason to schedule it.

I used to compare prices with PSS and HS but I lost that ability since the dissolution of PSS.

Who do you use and can you kindly list some prices so I can have a starting point with my rep?

 

[Pain Applicant1]

You can get a kit with a 20g Tuohy and LOR with syringes, drape, draw needles for between $10 and $14. Spinal needles can be had for between $1-2 if you are ok with not using BD.

Who are you buying from, please?

 

[Pain Applicant1]

23g are great. I bought a bunch of BD 23g 3.5” for around $2.10 each.

From where?

 

[BobBarker]

Search: 10 results found for "Spinal needle" • PHENTERSALES

This is the cheapest place I have found for BD Spinal needles. They have a lot more selection than last time I looked.

 

[BobBarker]

I am going to get my trays from Medline. They will make whatever you want. Maybe cheaper to use the same trays I have made. My rep is Nick Butera. [email protected]

Henry Schein can also do this for you.

 

[Crybaby]

Regarding contrast shortage- I split time in hospital and clinic. Hospital let me multidose the omni starting last Thursday. This week they are going to start having the pharmacy draw up into syringes under the hood.
In clinic, I just multidose each vial and discard what is left at end of day.

 

[BobBarker]

The kits are a lot cheaper than I posted above. The prices I quoted were for the Henry Schein kits. The medline ones are much cheaper. But they don’t have BD needles.

 

[Pain Applicant1]

Search: 10 results found for "Spinal needle" • PHENTERSALES

This is the cheapest place I have found for BD Spinal needles. They have a lot more selection than last time I looked.

I appreciate you, thanks. That site does work out to a bit less.

My prices used to be cheaper, maybe $4 for a Touhy. Now, it's over $7. I'm okay with paying a bit more if I have to. I can swing it but I don't know how the average person can deal with this inflation. Of course fuel and rent, but has anyone seen the price of eggs recently? Show of hands for anyone who feels that we're standing on the edge of a cliff looking down. Just kidding, don't answer. I don't want to hijack this thread.

 

[BobBarker]

The medline price for a kit with a Tuohy and LOR, drape, syringes, needles is what you are paying for a Tuohy alone

 

[Ferrismonk]

We use a simple kit which contains a few syringes, 18 & 25G 1.5" needles, a couple 2x2s, sterile prep/drape. Helps move things along but still have to draw up meds, drop quinkes, pointer, and extension tubing. I never use LOR syringe, so no issues there for me.

 

[geauxg8rs]

The kits are a lot cheaper than I posted above. The prices I quoted were for the Henry Schein kits. The medline ones are much cheaper. But they don’t have BD needles.

If you are using Henry Schein for your kits you might want to check out Cardinal. I used to have my kits from Schein, until the Cardinal rep told me that Henry Schein just out sources their kits
To Cardinal and then slaps a middleman charge of like 20 percent. Now I get them direct from Cardinal, same exact kit, just 20 percent cheaper than Schein.

I get my spinal needles from Clint. They are quite a bit cheaper than Schein.

 

[BobBarker]

Those Clint needles are super cheap. Thanks for sharing. I have a bunch of these 25g and 22g. They were $1.35 each. Not too bad for only having to buy 50-100 needles.


Exel spinal needles

 

[callmeanesthesia]

Those Clint needles are super cheap. Thanks for sharing. I have a bunch of these 25g and 22g. They were $1.35 each. Not too bad for only having to buy 50-100 needles.


Exel spinal needles

I’ve been using the Exel 22s and 25s for a few years. I like them as well as the BDs. Maybe a little better - I had an issue with the BD 25g where sometimes despite having it screwed on well, I’d aspirate and bubbles would leak in. I’d have to put a drop in the hub to form a tight seal. Haven’t had that issue with the Exels.

 

[Dr. Ice]

If you are using Henry Schein for your kits you might want to check out Cardinal. I used to have my kits from Schein, until the Cardinal rep told me that Henry Schein just out sources their kits
To Cardinal and then slaps a middleman charge of like 20 percent. Now I get them direct from Cardinal, same exact kit, just 20 percent cheaper than Schein.

I get my spinal needles from Clint. They are quite a bit cheaper than Schein.

Cardinal is way more expensive where I’m at