Multidose contrast

[Pain Applicant1]

Anyone here multidose their contrast? Is this norm? In fship, it was 50ml/procedure with a small fraction of that actually utilized. What did they care, the hospital was footing the bill. How things change when paying your own bills. What do you guys do?

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[nvrsumr]

Anyone here multidose their contrast? Is this norm? In fship, it was 50ml/procedure with a small fraction of that actually utilized. What did they care, the hospital was footing the bill. How things change when paying your own bills. What do you guys do?

I think there was a case of a CRNA doing pain procedures in Las Vegas using multdose vials who infected a bunch of patients with HepC.

There is a $1 port that you can buy to insert into top so you dont restick needles into the vial.

 

[specepic]

Yes I do. I never go back to the bottle once a case is started though, and if I do that bottle gets thrown out, same with any multidose med. Also, all meds get thrown out at end of day.

 

[Aether2000]

I have used single dose Omnipaque for multiple patients as a standard practice for over 13 years now with no meningitis, no epidural abscess, no signs of infection at all. Caveats: 1. use a new syringe AND needle each time the vial is accessed, even if it is for the same patient during the same injection (additional omni needed), 2. alcohol swab the top of the vial, 3. date the vial and discard after a reasonable interval of time, 4. do not inject air into the vial. I do not use a filter or access device or stopcock: my only needle used to access the vial is an 18ga needle. Each vial is used until it is gone (20cc vial, usually lasts a couple of days since my draw is 1-2cc per patient, but up to a week or two if we happen to have several vials open.

 

[bedrock]

Yes I do. I never go back to the bottle once a case is started though, and if I do that bottle gets thrown out, same with any multidose med. Also, all meds get thrown out at end of day.

Same-

 

[Pain Applicant1]

Thanks for taking the time to answer. Very much appreciated and helpful!



Just out of curiosity, what's the name of the $1 port that can be used?

 

[PinchandBurn]

in fellowship I believe we always used a brand new 10ml Omnipaque bottle on each patient. We never multi dosed.


Of note, I'm currently in a hosp based practice and have a 20ml Isovue contrast bottle that I open for each patient. Here are my reasons:
1) If you didnt draw up the medication, you have no idea what's in it. Additionally, and this was in a ASA newsletter a few years ago.....if your pain procedure door is open you never know who is trying to sabotage your meds (competing docs, a ticked off RN, terrorist,whomever....) IF you draw the med up you know exactly what's in it.

2) An attending also once told me this. If you multidose a vial that's supposed to be single dose (that's what it says on all Isovue bottles), and unfortunately something were to happen. Let's say arachnoidits,infection,etc. A root cause analysis may take place. If the patient or hosp/you sue the manufacture for a defective product. Let's say you claim that you used sterile techinque, masks,etc and now defferred the blame to the contrast/meds. They will try to find out what you injected and how much you drew it up,etc. IF they find out you had multi dosed a single dose vial, then you have no leg to stand on.

3) I believe this year it's mandated by CMS . I've been getting all those emails from ASIPP stating stating to fight this push for single dose of these meds

4)what would you do for your mom? Let's be honest, if money WASNT an object, how would you want your mom, dad, loved one to be injected. Wouldnt you want a single dose vial that you opened up? Not something that was sitting on the table opened by a RN, 5 hours ago, and was out of their site periodically throughout the day? There are just too many variables.


Again, I practice at a hospital where they pay for these supplies. I might be a little biased as a result. Regardless, of what we think on this matter it seems like CMS and JCCHO will mandate this anyways...

 

[bedrock]

in fellowship I believe we always used a brand new 10ml Omnipaque bottle on each patient. We never multi dosed.


Of note, I'm currently in a hosp based practice and have a 20ml Isovue contrast bottle that I open for each patient. Here are my reasons:
1) If you didnt draw up the medication, you have no idea what's in it. Additionally, and this was in a ASA newsletter a few years ago.....if your pain procedure door is open you never know who is trying to sabotage your meds (competing docs, a ticked off RN, terrorist,whomever....) IF you draw the med up you know exactly what's in it.

2) An attending also once told me this. If you multidose a vial that's supposed to be single dose (that's what it says on all Isovue bottles), and unfortunately something were to happen. Let's say arachnoidits,infection,etc. A root cause analysis may take place. If the patient or hosp/you sue the manufacture for a defective product. Let's say you claim that you used sterile techinque, masks,etc and now defferred the blame to the contrast/meds. They will try to find out what you injected and how much you drew it up,etc. IF they find out you had multi dosed a single dose vial, then you have no leg to stand on.

3) I believe this year it's mandated by CMS . I've been getting all those emails from ASIPP stating stating to fight this push for single dose of these meds

4)what would you do for your mom? Let's be honest, if money WASNT an object, how would you want your mom, dad, loved one to be injected. Wouldnt you want a single dose vial that you opened up? Not something that was sitting on the table opened by a RN, 5 hours ago, and was out of their site periodically throughout the day? There are just too many variables.


Again, I practice at a hospital where they pay for these supplies. I might be a little biased as a result. Regardless, of what we think on this matter it seems like CMS and JCCHO will mandate this anyways...

Any of the office-based pain docs know just how "mandated" this single use thing is now?

Seemed there was a loophole if you just didn't bill for contrast?
I save a lot more money by using my 50ml bottle for the entire morning of procedures (instead of 15 single use contrast vials), than by getting reimbursed $1.33 or so per case for contrast

I really hate being punished for the extreme end of the spectrum with guys who leave open bottles with the caps off, in their offices for weeks.

4)what would you do for your mom? Let's be honest, if money WASNT an object, how would you want your mom, dad, loved one to be injected. Wouldnt you want a single dose vial that you opened up?

I'd do the exact same thing for my mom. Reusing the same contrast bottle(unless you double dip on the same patient) for one procedure morning does not raise any risk of infection. (show me a study that proves otherwise)

I do procedures at an ASC two half-days/month and I hate all the waste that goes on there, seeing 28ml wasted of the 30ml bottle for a single patient, and all the extra unnecessary equipment, time, and paperwork

Makes me feel like I need to go home and recycle some more.........

 

[Aether2000]

I read the CDC position paper on this and it is based on a lot of theoretical nonsense but no hard facts. If office based practices have to buy a bottle of omnipaque for every patient, given that you do not get reimbursed for the drug at all, with falling reimbursement it makes continued use of single dose vials untenable. Of course the hospitals are reimbursed handsomely at 2.5-5 times the rate for exactly the same procedure as performed in the office. Double standard? Yes it is. Pay me the same the hospitals get for their procedures and I will be happy to open a new vial for every patient.

 

[pmrmd]

Ditto algos' methods. Always use new syringe. Sometimes I keep the same 18g needle in to draw contrast or steroid out, but the syringe is always new, even if more of the medication is needed. No infections ever.

 

[lobelsteve]

Ditto algos' methods. Always use new syringe. Sometimes I keep the same 18g needle in to draw contrast or steroid out, but the syringe is always new, even if more of the medication is needed. No infections ever.

Same. But since I use my 18G or 20G to mark the skin for scout, if I need more, I open a new 18G and syringe before resticking a vial.

7 yrs no issue, and my fellowship did the same thing since 1990 with no reported infections.

 

[Jcm800]

Same. But since I use my 18G or 20G to mark the skin for scout, if I need more, I open a new 18G and syringe before resticking a vial.

7 yrs no issue, and my fellowship did the same thing since 1990 with no reported infections.

I vial a day of 50 cc. If opened at the end of the day will use again the next day. Never re-draw. If needed get a new needle and syfinge. Alcohol wipes etc. no problems. Especially now since since contrast is not reimbursed In the office. Hospitals are the enemy t the doctor and patients

 

[bedrock]

I vial a day of 50 cc. If opened at the end of the day will use again the next day. Never re-draw. If needed get a new needle and syfinge. Alcohol wipes etc. no problems. Especially now since since contrast is not reimbursed In the office. Hospitals are the enemy t the doctor and patients

I know some carriers don't reimburse for contrast and in 2012 the ILESI codes include contrast, but can't you bill for contrast with other procedures?
MBB/TFESI, joint injections?

I know you don't get reimbursed a lot, but an extra $2 a case still helps.

 

[pjuer]

Same as Algos, but throw out bottle at end of day.