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Discussion

EPI Shortage!

Blahh! My hospital now has a "Code Epi" shortage. What???

We draw up epi like it's candy in my cicu (ok so I can see why there might be a shortage) but now we are having to draw it up, dilute it then draw up our dosage for codes; and it's only good for an hour after making it. So much for trying to get your code meds ready in advance for that chest closure/exploration/elective ecmo cannulation...etc.

Not even sure what could come next in regards to med shortages. Epi, really??

:no:

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    • Expert

    So far we've escaped that particular issue... we still have a ready supply of epi minijets. We have one at every bedside, along with a minijet of bicarb and one of calcium chloride. If we have a kid who's teetering we'll put a stopcock on the Luer lock connector and have a dose drawn up, still attached to the stopcock but ready to go. But lately our intensivists have been leaning toward the "epi spritzer"... the 1:10,000 concentration diluted 1mL : 10mL NS, of which we might give 1mL at a time just to goose the BP. So much for PALS algorithms...

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    • Author

    We also have a bristojet of epi at every bedside, and a PRN code dose ordered on all patients. Typically it's not given until the MD is at the bedside, but in certain kiddos we may give it before the doc gets there. Now though we will no longer be able to keep a bristojet at the bedside but rather have to pull out the "kit" from the pyxis or crack the code cart. Very scary in my opinion when these kids go south so quickly. We do not as routinely use the "epi spritzers", this is commonly done in our PICU, less in the CICU though I have seen it done. One of the concerns was that the picu was using the bristojets to dilute to the "spritzer" concentration, therefore wasting more EPI. Now we will be stocked with the lower concentration but in my unit where we don't use it as much we are stuck with making our code epi during the code, of course there will be some in the code carts as well, it's just going to overall delay the time that first dose gets in. When there is a code usually the second responder immediately gets that bristojet out of the bedside cart but now there will be a delay

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    • Expert

    What manufacturer are you using? Ours is from Hospira, which is in short supply but we must have a stockpile. We don't open the minijet unless we're reasonably sure we're going to use it. We rarely need it for our PICU patients but frequently do for our CVICU patients... like recently. What anaesthetist brings back a kid with a CVP of 4, and LAP of 3, bleeding and hypocalcemic... no matter how high the epi and norepi are cranked? No spritzer for that.

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    • Author

    I can't recall the name of the company, but I was talking to one of our pharmacists yesterday and it's because of the contaminated drugs from that New England pharmacy company. All the sister pharmacies to it are under investigation and cannot manufacture anything until cleared. They are hoping we will be back in supply after January...until then, hope we have fewer codes!

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    • Expert

    I wondered if that was it. 2 months is a long time to go short with something like that... and imagine the drug errors if you have to resort to using the 1mg/mL concentration! It could be a disaster.

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