Omnipaque 2.0

[macman]

Thought I would share our current Omnipaque Strategy:

Hospital pharmacy takes a 50 ml vial and divides it into 25 2 ml doses in separate syringes. This is done under their hood (they already do this with certain specialty meds)

These doses are packaged, dated together in a dated bag, and refrigerated for a 10 day life span

when my day surgery team tees things up they pull one dose per pt that a.m.. If I need more than 2ml they can borrow from a later case and grab a replacement from the fridge for that later case to warm up

Upon starting a case my assistant squirts the Omnipaque in a sterile well on my tray and I draw from that. I initially tried directly drawing from the syringe by putting an 18G inside the tip of the syringe but that did not work very well I assume due to the viscosity and small volume. I also tried using a filter straw to draw up from the well which also did not work well (I was avoiding using a needle as the well is thin plastic and I did not want to puncture it. So know I just suck it up with the syringe tip w/o a needle or straw and it works well

Most cases I am using < 2 ml anyway

That is what we are doing for now, so we can get 25 cases from one vial

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[lobelsteve]

Thought I would share our current Omnipaque Strategy:

Hospital pharmacy takes a 50 ml vial and divides it into 25 2 ml doses in separate syringes. This is done under their hood (they already do this with certain specialty meds)

These doses are packaged, dated together in a dated bag, and refrigerated for a 10 day life span

when my day surgery team tees things up they pull one dose per pt that a.m.. If I need more than 2ml they can borrow from a later case and grab a replacement from the fridge for that later case to warm up

Upon starting a case my assistant squirts the Omnipaque in a sterile well on my tray and I draw from that. I initially tried directly drawing from the syringe by putting an 18G inside the tip of the syringe but that did not work very well I assume due to the viscosity and small volume. I also tried using a filter straw to draw up from the well which also did not work well (I was avoiding using a needle as the well is thin plastic and I did not want to puncture it. So know I just suck it up with the syringe tip w/o a needle or straw and it works well

Most cases I am using < 2 ml anyway

That is what we are doing for now, so we can get 25 cases from one vial

Same. But 4 day refrigerated, 30hrs not. 3 way sterile stopcock on my tray.

 

[Taus]

This only works for hospital affiliated practices…. No dice for the private practitioner. Local hospitals and private pharmacies won’t take your vials and divide them unless it was direct from manufacturer.

 

[bedrock]

I just reuse the contrast bottle until it’s out or it’s the end of the day. Done. No extra bureaucratic nonsense.

 

[Baron Samedi]

I just reuse the contrast bottle until it’s out or it’s the end of the day. Done. No extra bureaucratic nonsense.

Be really, really careful. This goes against standard USP standards and current guidelines(ASRA). You might open yourself up to risk. A lawyer would have a field day if a patient developed an infection.

 

[bedrock]

Be really, really careful. This goes against standard USP standards and current guidelines(ASRA). You might open yourself up to risk. A lawyer would have a field day if a patient developed an infection.

I’m more concerned about potential complications from not using contrast at all due to the shortage.

I’ve never had an infection. Practicing pain for over a dozen years, performed over 20,000 injections including stims without an infection.

Maybe the bureaucrats have their guidelines wrong as they aren’t actually based in science but are really based in the art of politics and trying to look like they are doing something.

 

[Baron Samedi]

I’m more concerned about potential complications from not using contrast at all due to the shortage.

I’ve never had an infection. Practicing pain for over a dozen years, performed over 20,000 injections including stims without an infection.

Maybe the burecrats have their guidelines wrong as they aren’t actually based in science but are really based in the art of politics and trying to look like they are doing something.

I don't disagree with you, just saying from a legal standpoint this shortage puts us all in a bind.

The only positive I've gotten out of all this is I've been able to brush up on some ultrasound skills I've neglected.

 

[lobelsteve]

I’m more concerned about potential complications from not using contrast at all due to the shortage.

I’ve never had an infection. Practicing pain for over a dozen years, performed over 20,000 injections including stims without an infection.

Maybe the burecrats have their guidelines wrong as they aren’t actually based in science but are really based in the art of politics and trying to look like they are doing something.

If the vial is in your control (your the only one who uses it and draws the medicine), then as long as you use a new needle and syringe every time you access the bottle- there is no risk of infection.

 

[Taus]

If the vial is in your control (your the only one who uses it and draws the medicine), then as long as you use a new needle and syringe every time you access the bottle- there is no risk of infection.

Agreed- I’m personally 100% ok getting my own spine and that of my family injected in that fashion… that said, it’s indefensible god forbid anything happens. Cdc, fda, sis, asra and pharmacy societies specifically rec don’t do it.

 

[Dr. Ice]

Agreed- I’m personally 100% getting my own spine and that of my family injected in that fashion… that said, it’s indefensible god forbid anything happens. Cdc, fda, sis, asra and pharmacy societies specifically rec don’t do it.

It’s especially worse for really really deep pockets…

 

[painfree23]

Be really, really careful. This goes against standard USP standards and current guidelines(ASRA). You might open yourself up to risk. A lawyer would have a field day if a patient developed an infection.

Are u writing in ur notes the methods of drawing up contrast? How would the lawyers know?

 

[RoloTomassi]

Are u writing in ur notes the methods of drawing up contrast? How would the lawyers know?

Let's not give anybody ideas on this public forum

 

[Ducttape]

I’m more concerned about potential complications from not using contrast at all due to the shortage.

I’ve never had an infection. Practicing pain for over a dozen years, performed over 20,000 injections including stims without an infection.

Maybe the bureaucrats have their guidelines wrong as they aren’t actually based in science but are really based in the art of politics and trying to look like they are doing something.

know someone who thought this way....

If the vial is in your control (your the only one who uses it and draws the medicine), then as long as you use a new needle and syringe every time you access the bottle- there is no risk of infection.

1. unless you are putting that vial in your pocket, it is not 100% in your control throughout the day.
2. there is always a risk. in fact, there is a risk even with a brand new vial. admittedly, the risk is very low.
3. if you multidose, please wipe off the top before accessing.

 

[lobelsteve]

know someone who thought this way....


1. unless you are putting that vial in your pocket, it is not 100% in your control throughout the day.
2. there is always a risk. in fact, there is a risk even with a brand new vial. admittedly, the risk is very low.
3. if you multidose, please wipe off the top before accessing.

My room is for me only. I am the only one who uses it. My nurses do not draw up meds for me. Unless someone sneaks in to do harm....

 

[Ducttape]

you didnt see me sneak in 2 weeks ago on Monday...



we used to see those tiny bugs buzzing around the OR. i have had a patient or thirty come in with bed bugs.

just saying...

 

[Ducttape]

FWIW, im sure you and bedrock et al do it the right way.

i was posting more as a public service announcement for lurkers who may view the thread and change their clinical approach, but do wo without full understanding of the process.

 

[Taus]

anyone been able to order? Shanghai factory reportedly 100-% capacity as of 6/8. No dice at my office or asc.

Able to get 140 and 350 concentrations, both off label for epidural use. I checked with pharmacist consultant- cannot just dilute the 350 with steroid water or saline. It’s apparently not just the concentration- also other components in it. Bummer.

 

[RoloTomassi]

anyone been able to order? Shanghai factory reportedly 100-% capacity as of 6/8. No dice at my office or asc.

Able to get 140 and 350 concentrations, both off label for epidural use. I checked with pharmacist consultant- cannot just dilute the 350 with steroid water or saline. It’s apparently not just the concentration- also other components in it. Bummer.

140 and 350 contraindicated for intrathecal, not specifically epidural. Would you be comfortable injecting epidural? I have some available but not sure.

 

[Taus]

140 and 350 contraindicated for intrathecal, not specifically epidural. Would you be comfortable injecting epidural? I have some available but not sure.

About as comfortable as injecting gad…

 

[Taus]

What are people seeing out there in terms of getting orders?

 

[lobelsteve]

Got 3 boxes of 10 in this week. Have been getting compounded from existing stock and set for next 6 months.

 

[Tboned]

Our ASC just received 8 boxes ( 10 each maybe?)

 

[Drd105]

McKesson is telling me 300 is a lost cause and pushing the 350. is anyone using that?

 

[BobBarker]

Looks like some is becoming available through Henry Schein

 

[Taus]

Looks like some is becoming available through Henry Schein

As per pharmacy consultant at my asc, cannot just dilute- see attached

I’d be about as comfortable injecting this with an epidural as gadolinium

 

[RoloTomassi]

McKesson is telling me 300 is a lost cause and pushing the 350. is anyone using that?

I bought some then read the insert that said the same thing Taus posted, got scared and returned it.

 

[Drd105]

I bought some then read the insert that said the same thing Taus posted, got scared and returned it.

Thanks- I’ll just hop on the waiting list. And check Henry schein- thanks taus!

 

[lobelsteve]

Getting 1-2 boxes per week.

 

[runfastnow]

Who's your guy/gal?

Currently getting zero boxes per week and orders rejected.

 

[lobelsteve]

Love from the hospital.

 

[bedrock]

You need a good materials person. Ours has been doing this for years and is also finding some contrast in various places.

 

[Ligament]

For those of you NOT owned by (and/or supplied by) a hospital, where are you finding contrast, dextrose, ropivicaine, lidocaine? Any word on when supply will be restored? This is absurd.

 

[painfree23]

For those of you NOT owned by (and/or supplied by) a hospital, where are you finding contrast, dextrose, ropivicaine, lidocaine? Any word on when supply will be restored? This is absurd.

Dextrose? What for?

 

[DODOCSS]

Dextrose? What for?

prolo

 

[Dr. Ice]

Been able to get Omni and lido, don’t use ropi or dextrose

Pretty sure it’s been the usual suspects, but I’ll find out..McKesson, cardinal, medline

 

[Pain Applicant1]

Are u writing in ur notes the methods of drawing up contrast? How would the lawyers know?

I know the answer to this

 

[GlowInTheDark]

I was reviewing the notes of a patient who wanted to transfer care to my practice from a hospital based doc.

Had gotten 3 epidurals in last 6 months…procedure notes had “1 mL Omnipaque used, 49 mL wasted”

No words.

No words at all.

 

[Ligament]

Funny enough, my ASC is able to get Omnipaque as the ASC is invovled with the hospital. My private clinic, on the other hand, is not allowed any at all.

This is likely another attempt to kill off private practices. Kill them financially, kill them with supply chain inequities, etc.

 

[promethius]

Just for disclosure purposes, my practice is not affiliated with a hospital. On a related item, I have not been able to get either lidocaine 1% or 2% for over 3 months now. Every major distributor I have checked with is either out-of-stock of or on allocation for lidocaine. I put an allocated order in for lidocaine with McKesson about 3 months ago, and last I heard, the order will not be filled until 2023. Any suggestions for where to get lidocaine for private practices will be much appreciated.

 

[mohandess]

I did get several vials of Omnipaque 350. Anyone used this for injections or know how safe it is for epidurals? It says not for intrathecal use but wondering what everyone’s experience is?

 

[BobBarker]

Seriously, schedule one si joint at the hospital a week and take the remaining 28ml of lidocaine, 28ml of bupivicaine, and 48ml of contrast with you.

 

[callmeanesthesia]

Seriously, schedule one si joint at the hospital a week and take the remaining 28ml of lidocaine, 28ml of bupivicaine, and 48ml of contrast with you.

 

[Ligament]

This is becoming a serious issue. Some practice are going to shut down fairly soon without supply and without the ability to conserve single dose containers.

 

[Dr. Ice]

Somehow my asc got a bunch of omnipaque 240 50ml bottles. No connection to a hospital. I just steal from them for my in office procedures if I need to

 

[Ducttape]

Funny enough, my ASC is able to get Omnipaque as the ASC is invovled with the hospital. My private clinic, on the other hand, is not allowed any at all.

This is likely another attempt to kill off private practices. Kill them financially, kill them with supply chain inequities, etc.

probably has to do the economy of scale, not to do with PP specifically.

as a distributor, do you sell your limited supply to an ASC or hospital that buys in the thousands of units, or do you sell to the private practice that maybe orders tens or maybe a hundred units?

 

[Ligament]

Hospital pharmacy takes a 50 ml vial and divides it into 25 2 ml doses in separate syringes. This is done under their hood (they already do this with certain specialty meds)

These doses are packaged, dated together in a dated bag, and refrigerated for a 10 day life span

Is this still your strategy, and do you know how your hopital arrived at a 10 day refigerated life span?

 

[Ducttape]

cdc suggests 9 days.




they probably used the smell test.

 

[mid|ine]

Anyone else getting shipments? We are getting very low and still no sign of getting any.

 

[GlowInTheDark]

I did get several vials of Omnipaque 350. Anyone used this for injections or know how safe it is for epidurals? It says not for intrathecal use but wondering what everyone’s experience is?

This is from SIS almost 10 years ago:

https://cdn.ymaws.com/www.spineinte...r/factfinder/Contrast_Medium_FF_11-18-201.pdf

 

[strike5858]

I did get several vials of Omnipaque 350. Anyone used this for injections or know how safe it is for epidurals? It says not for intrathecal use but wondering what everyone’s experience is?

Wondering the same thing. I think I read on here some people would dilute it down with normal saline.