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Shortage: Sterile Water & Sodium Chloride 0.9% for Injection

April 12 , 2018

On behalf of Tara Dumont, Manager, Medication Management

Please find out UPDATED Safter Practice Notice with regards to the Shortage: Sterile Water and Sodium Chloride for 0.9% for Injection

Please note that the list of Medications that MUST be reconstituted ONLY with Sterile Water has been updated.

Issue:
There is a national shortage of 10 mL and 20 mL vials of Sterile Water and Sodium Chloride 0.9% for Injection. 

Actions:
Reserve sterile water for injection vials for those medications that can only be reconstituted with sterile water.

  • Refer to the AHS Provincial Parenteral Monographs for information on alternative sterile liquids for reconstitution
  • See Appendix for a list for medications that must be reconstituted with sterile water

When clinically appropriate, collaborate with prescribers to switch IV medications to oral formulations. Consult Pharmacy as needed.

The minibag stock has now stabilized.
Infection Prevention and Control has agreed that the use of minibags for single patient use is temporarily approved for reconstitution of medications during this shortage.

  • When appropriate, use a reconstitution device
  • When preparing IV direct medications, withdraw desired reconstitution  volume from minibag using aseptic technique.
  • Use one bag- for one patient- for one hour.
  • Label the minibag and discard used minibag after one hour.
  • Multiple accesses to a single use minibag increases the risk of contamination. Remember new needle, new syringe every time.

Prefilled Sodium Chloride 0.9% syringes must be used to flush vascular access devices only and must not be used for reconstituting medications. 

http://www.ismp.org/newsletters/acutecare/articles/20061116_2.asp 

For medication reconstitution DO NOT SUBSTITUTE:

  • Sterile water for irrigation
  • Sterile water for inhalation
  • Sodium Chloride 0.9% for irrigation
  • Bacteriostatic water for injection

Note: The use of sterile water and normal saline products for wound care should be reviewed to identify alternate products and discontinue the use of sterile vials.

Medications that MUST be reconstituted ONLY with sterile water 

UPDATED APRIL 4, 2018 

 Refer to Provincial Parenteral Monographs for details

  • aldesleukin
  • amphotericin B
  • amphotericin B liposomal
  • ampicillin*
  • anti-thymocyte globulin, RABBIT
  • asparaginase (Kidrolase®)
  • azaTHIOprine
  • AZIthromycin
  • basiliximab
  • bivalirudin
  • cefazolin* (1 gram vials only)
  • cefuroxime*
  • ceftazidime*
  • cloxacillin*
  • dantrolene
  • deferoxamine
  • digoxin Immune Fab
  • erythromycin*
  • estrogens, conjugated
  • infliximab (Inflectra brand only)
  • interferon alfa-2b
  • OLANZapine
  • pamidronate
  • pembrolizumab
  • pentamidine
  • piperacillin
  • pralidoxime
  • rifAMPin
  • streptomycin
  • t-PA (Cathflo) - new as of April 4th
  • vancomycin
  • voriconazole

*These drugs have historically been reconstituted using the Mini Bags Plus® system. There is no published data available to support that they can be reconstituted with any product other than SWI. Currently Pharmacy Services is investigating.

Provincial Monographs: http://webappsint.albertahealthservices.ca/pharmacy/pm/index.asp

Information Provided by AHS Drug Information Team

Contact Information:
For further information, contact your site Pharmacy Department or as below,

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