To: Physician, Nursing and Pharmacy Staff
From: Maryna Shayuk, MD, Chair, Pharmacy and Therapeutics
Alan Mader, PharmD, Pharmacy Clinical Coordinator
Re: Sodium Bicarbonate Injection Shortage
Sodium Bicarbonate 8.4% Injection 50 mL is currently on shortage. There are different projections on how long this shortage will last, with some continuing until 2019. Sodium Bicarbonate is used for CODE BLUE situations and is available in Crash Carts. It is also used for Open Heart Surgery and for Toxicologic Emergencies.
The supply of Sodium Bicarbonate 8.4% Injection has not been stable for some time.
With uncertain supply, steps to maintain availability for Crash Cart Supply and for Open Heart Surgery need to be implemented.
Pharmacy will sequester supply to maintain stock for Crash Carts and for the surgical Open Heart room. When orders are received for sodium bicarbonate infusion, pharmacy will directly provide recommendation with the ordering physician to use sodium acetate injection. Information on the use of sodium acetate infusion is shown below:
Toxicologic Emergencies – Use Sodium Acetate 2 mEq/mL
a. Bolus (if required) – 1 mEq/kg/D5W 500 mL infused over 20 minutes (consistent
with information presented by ASHP). 150 mEq maximum to avoid osmolarity issues.
For patients over 100 Kg, infuse over 30 minutes.
b. Maintenance: Na Acetate 150 mEq/D5W 1000mL infused at 200 mL/hr for adult
patients. 3 bag limit. The same rate would be used for urine alkalinization.
We are anticipating that the shortage will end before supply becomes depleted. If that is not the case, sodium acetate may also be used in Code situations as follows:
Crash Cart/Code situation – Requires dilution/infusion. 50 mEq Sodium Acetate added to 100 mL D5W (125mL TV) administered over 10 minutes
To: Physician, Nursing and Pharmacy Staff
From: Alan Mader, Pharmacy Clinical Coordinator
Re: Sodium Phosphate Injection Shortage
Potassium Phosphate Injection Shortage
Both Sodium Phosphate and Potassium Phosphate Injection are on shortage. Currently the system is in very low supply of Sodium Phosphate and pharmacy has transferred supply from the Huntley campus to the McHenry campus. The Sodium Phosphate shortage is projected to last 2 to 4 weeks. The Potassium Phosphate shortage is projected to last until late December.
These shortages have been newly announced.
Sodium Phosphate supply is very low within the system (17 vials). While Potassium Phosphate is currently in greater supply, projections indicate that it may remain on the shortage list an additional month longer that Sodium Phosphate.
Please conserve both Sodium and Potassium Phosphate Injection. Wherever possible, please consider oral replacement with Neutra Phos equivalent. Each packet contains: Sodium 160 mg (7.1 mEq), Potassium 280 mg (7.1 mEq), Phosphorus 250 mg (8 mMol).
From: Dima Awad, PharmD, MS, System Director of Pharmacy Services
Date: August 31, 2017
Re: D5W/0.45% NS Shortage
We are experiencing a shortage in D5W/0.45% NS.
Medications including IV fluid shortages keep occurring at great frequency, this situation has been worsening over the past several years due to multiple factors such as fewer suppliers, inability to acquire active ingredients, issues with packaging and more.
Currently, Pharmacy services has a 1 day supply of D5W/0.45% NS. When the current supply of D5W/0.45% NS becomes depleted, a plan for automatic substitution needs to be implemented. This is not a new workflow nor is it a change in practice in case of shortages.
When supply becomes depleted, Pharmacy services will initiate substitution with D5W/0.225% NS, to be administered at same infusion rate that was ordered. Pharmacy services will place “Substituted for D5W/0.45% NS” in the comment section of the Paragon order so that nursing is aware of the change. This substitution has been approved by The Pharmacy and Therapeutics Committee. Pharmacy will also maintain vigil on availability of D5W/0.225%, as we anticipate that increased use will decrease supply.
Due to drug manufacturing shortages as reported by the drug vendor, Bracco Diagnostic on May 21, 2014 scheduling of outpatient Hepatobiliary studies, with cholecystokinin (CCK), will be discontinue. . The drug, Kinevac, has no known alternatives, prompting this action.
The Centralized Scheduling Department has been requested to retain a list of patients requiring this test. Once supplies become available, they will coordinate the scheduling of these patients.
Should you have any questions, please feel free to contact me at 815-759-4080.
– John Heinrich – Director, Medical Imaging – CHS
We wish to inform you there is a disruption to the current Nuclear Medicine supply chain. Effective immediately, there is a stock out situation at the sole manufacturer of MAA (macro aggregated albumin), which is used to perform V/Q lung scans. The company anticipates having commercial supply available mid-October.
Fortunately, since best practice is to use CT pulmonary angiography for the vast majority of clinical situations where image evaluation for suspected pulmonary embolism is needed, we anticipate that this shortage should have limited impact.
Please feel free to contact any of the Radiologists, at 815-759-4262, to discuss clinical alternatives.
We will provide communication one we have confirmation the shortage has ended.
We appreciate your understanding during this experience.
Philip Gilroy, M.D. – McHenry Radiologist and Imaging Associates
John Heinrich – Director, Medical Imaging
Due to manufacturing issues there is a national shortage of doxycycline. The following recommendations for patient care were issues by the CDC.
TUBERSOL®, a product of Sanofi Pasteur Limited, is in shortage nationwide until at least the end of May 2013. TUBERSOL® is one of two purified-protein derivative (PPD) tuberculin products that are licensed by the United States Food and Drug Administration (FDA). The manufacturer notified CDC that 50-dose vials of TUBERSOL® are unavailable and that the supplies of 10-dose vials will be limited. This notice advises public health officials, clinicians, and workers in occupational health and infection control about how to adapt to the shortage.