Is anyone filtering IVIG doses that the pharmacy is drawing up and pooling into bags? We had an issue in the past with the silicone oil in syringes used to transfer the product to bags, creating particles. We started the practice of filtering when preparing and on administration but this is time consuming and we are curious what others are doing.

Thank you,
Shannon Manzi
Boston Children's Hospital

How are other organizations handling Bicillin L-A 600,000 units/mL shortage? We have the 1.2 mu and 2.4 mu syringes still available but treat a pediatric population that may need a partial dose. There are no markings on the syringe. How are nurses administering a partial dose? Are nurses transferring it to a different syringe or is pharmacy preparing it?

Hello,

I am wondering how other organizations prepare blood factor doses in the pharmacy if you have a iv workflow management system. Do you round the dose of blood factor vials (i.e Recombinate, Benefix) to a certain value? We currently do for KCentra only. Because the other factors have a variable range of units, we cannot use our IV workflow management system (we utilize DoseEdge) to prepare doses of blood factors and are looking for potential ways to do so.

Is anyone using the Vancomycin 1.75mg/350mL premix IVPB having issues with the bags bursting when tubing? We just started using these a week ago and have had 3-4 bags burst. Reaching out to the manufacturer (Xellia) but wondering if others have experienced this also? Thanks.

We have been working on a solution that involves pharmacy compounding our bupivacaine w/Epi doses. Interested in what other facilities are doing to combat the shortages. Thank you!

Hi all,

We've recently heard about the inability to use albumin tubing with our large volume pumps and subsequent reliance on running albumin infusions to gravity. Anyone else heard this from frontline staff?

For reference, we have BBraun Infusomat Space Pumps with an upcoming transition to the ICU Medical Plum 360.

Thank you!
Sheena Burwell, PharmD, BCPS, CTTS
Medication Safety Specialist
WVU Medicine - WVU Hospitals

Patients presenting with insulin pumps is becoming common in our hospitals. We have provider and nursing processes to identify and document insulin pumps yet these are often not documented before orders are entered and verified. Pharmacists are aware that pumps can be continued during the hospital stay but haven't hardwired the thought process to verify pump status before verifying insulin orders. Our EHR does not fire duplicate warnings until the 3rd insulin has been ordered to reduce alert fatigue.

Hello colleagues,

The ASPEN recommendation for maximum peripheral parenteral nutrition osmolarity (900 mOsm/L) is rated "weak." Literature supports a higher osmolarity (1200 mOsm/L) for neonates.

Do you allow for a higher osmolarity PPN in adults? If so, how do you justify it from a safety/risk for patient harm perspective?

Thank you,
Megan Fragale, PharmD, MS, BCPS
Medication Safety Officer
Skagit Regional Health

Good morning.

We recently started using EKOS for pharmaco-mechanical thrombolysis. The cardiologist indicated that a typical dose would be 6 mg/50 ml over 6 hours but he may want more over a longer period of time depending on the situation. In our EHR, we built 2 options: 6 mg/50 ml and 12 mg/100 ml and a typical rate would be 1 mg/hr per catheter. For those pharmacies compounding alteplase (using Cathflo), what BUD are you assigning the compound? The package labeling for Cathflo says this:

Does anyone have better directions when Hyaluronidase is administered via the IV catheter?
Lexicomp states "Intradermal or SUBQ: Inject a total of 1 mL (15 units/mL) as 5 separate 0.2 mL injections (using a tuberculin syringe) around the site of extravasation; if IV catheter remains in place, administer IV through the infiltrated catheter; may repeat in 30 to 60 minutes if no resolution (Ref)."

Does the above mean to administer the 1ml volume that would have been administered intradermal, via the IV catheter?