Propofol shortage, anyone?

[StayLost, BSN, RN]

We have been out of Propofol for about 3-4 weeks. We have been mostly using Fentanyl & Versed gtts. I think the big problem is our shortage of D50 amps, epi, & bicarb amps. It's time consuming to draw up during a code.

[wtbcrna, MSN, DNP, CRNA]

I've never used Propoven. I don't think anybody knows about it up here.

Oh, I looked -- non-American propofol. I work for the Feds. I bet we won't import it.

I am military we have been using propoven exclusively for a few weeks now. I don't see why your facility would be any different. What are they using in the ORs there?

The biggest thing to remember about propoven is that it doesn't have any preservative added to it so it must be discarded every 6hrs instead of the usual 12hr with regular propofol.

[JulieCVICURN, BSN, RN]

We were out of Propofol for a couple of months but just got it back about 3 weeks ago. Our current shortages are heparin, epi, and morphine (in the 4cc vials, not the 10cc). We were using the versed/fentanyl combo as well, which I agree does not work as well as Propofol.

[Hoozdo, ADN]

In the southwest, we had a Propofol shortage about 6 months ago but it has resolved.

We did use a different brand during the shortage. I did see more Precedex use

during the shortage.

We are definitely going through the shortage of epi and D50 amps. So far, no

shortage of calcium or sodium bicarb. In my latest code a couple of weeks ago,

we did still have epi amps in the code carts. I have had to give D50 about 3 times

in the last 2 weeks and had to sloooooowly draw it out of a glass vial.

[CNL2B]

I am military we have been using propoven exclusively for a few weeks now. I don't see why your facility would be any different. What are they using in the ORs there?

The biggest thing to remember about propoven is that it doesn't have any preservative added to it so it must be discarded every 6hrs instead of the usual 12hr with regular propofol.

We have some propofol -- just not much. It is being allocated to the ORs only. I think they have enough, but there isn't enough to go around for the ICUs, etc.

Next time I go in, I'm going to ask our PharmD about Propoven and if we are considering it. According to the article that was posted upthread, this shortage isn't supposed to be over until the fall, so. I've never seen my facility use imported medication and I don't know if it is even possible -- I'm a little surprised to hear the military is doing it (well, I guess they can pretty much do what they want though.)

[sunnycalifRN]

Propofol is used sparingly in our ICU. We have switched to Precedex.

Same here, in California Bay area. We've been told that the shortage of propofol is nationwide. The pharmacists are calling it the "Michael Jackson" effect . . . I guess insomniacs are using it for restful sleep?!?!

[CrufflerJJ, RN]

Propofol is used sparingly in our ICU. We have switched to Precedex.

My condolences to you.

Precedex may be OK for weaning (some) folks from a vent, but has not impressed me with its ability to sedate people.

There's a patient in my ICU right now on 400 mcg/hr fentanyl + 40 mg/hr versed. That person is still fairly awake. In patients like that, I'd much rather be able to sedate them with Propofol. Propofol WORKS.

[XingtheBBB, BSN, RN]

Yup. The POINT of precedex is that it's not a sedative, although it's an anxiolytic.

We switched to fent + midaz or loraz gtts although we're starting to get the propofol back. Diprivan only, no more Hospira so the cost has gone up.

Linking this to Micheal Jackson is... well... even if someone says it jokingly, it will be taken as serious by someone less informed. Unprofessional. I think it's ignorant and not even funny, IMHO. He doesn't deserve to be linked to such a useful drug and I'm tired of hearing his name. Like I said, JMHO.

We're limiting the amount of epi we keep in carts. Dumb, since now we open two carts for most codes. Cracking the second cart used to be a rarity. Dilaudid tubexes come and go, often side by side with ampoules. I grab the tubex since it's easier but a co-worker refuses to use the ampuole because it's "different" and she "doesn't trust it" LOL. Wonder what she's doing with her hypoglycemics because, yes, we only have D50 in vials. Just like when I started.

[NocturneRN]

Yup. The POINT of precedex is that it's not a sedative, although it's an anxiolytic.

We switched to fent + midaz or loraz gtts although we're starting to get the propofol back. Diprivan only, no more Hospira so the cost has gone up.

Linking this to Micheal Jackson is... well... even if someone says it jokingly, it will be taken as serious by someone less informed. Unprofessional. I think it's ignorant and not even funny, IMHO. He doesn't deserve to be linked to such a useful drug and I'm tired of hearing his name. Like I said, JMHO.

We're limiting the amount of epi we keep in carts. Dumb, since now we open two carts for most codes. Cracking the second cart used to be a rarity. Dilaudid tubexes come and go, often side by side with ampoules. I grab the tubex since it's easier but a co-worker refuses to use the ampuole because it's "different" and she "doesn't trust it" LOL. Wonder what she's doing with her hypoglycemics because, yes, we only have D50 in vials. Just like when I started.

One of the things that bothers me about Dilaudid is how much we waste in my hospital. In our ER pyxis, Dilaudid comes only in cartridges of 1 or 2 mg. Since (depending on the presenting problem) the doctor often wants to start with .5 mg, and since our documentation system doesn't permit documenting more than once on the same cartridge, we end up giving the .5 mg, disposing of the remaining .5 mg, and opening a new one if the patient ends up needing another .5 mg. And, when the 1 mg cartridges are in short supply, it means using a 2 mg cartridge, and wasting 1.5 mg. I know Dilaudid doesn't cost much, but what a waste!

[XingtheBBB, BSN, RN]

Thats our problem with Fentanyl, sometimes we give 100 mcg but usually it's 50. Our policy requires the nurse to waste the rest AT the time of removal from pyxis, in that session, NOT to log out and and back in. Soooo... if the unit is chaotic and another nurse isn't readily available to witness a waste... do you think pts are given the prn at that time or it's pushed aside for another 15 minutes?

Not good. But I do it, too. Don't wanna get scolded! Don't want suspicion.

[wtbcrna, MSN, DNP, CRNA]

We have some propofol -- just not much. It is being allocated to the ORs only. I think they have enough, but there isn't enough to go around for the ICUs, etc.

Next time I go in, I'm going to ask our PharmD about Propoven and if we are considering it. According to the article that was posted upthread, this shortage isn't supposed to be over until the fall, so. I've never seen my facility use imported medication and I don't know if it is even possible -- I'm a little surprised to hear the military is doing it (well, I guess they can pretty much do what they want though.)

Propoven is approved by the FDA, so it is available all over the US. The military has to follow the same guidelines as any other JC accredited hospital.

[CrufflerJJ, RN]

We're limiting the amount of epi we keep in carts. Dumb, since now we open two carts for most codes. Cracking the second cart used to be a rarity. Dilaudid tubexes come and go, often side by side with ampoules.

And the latest shortage to hit my hospital.....D50!!! Yup, there's a shortage of D50 in prepacked syringes and vials.

Along with the epi shortage, vanc shortage, paralytic (roc, vec, succ,....), propofol, and everything else shortage. Then there's the Protonix hassle where the prepacked 100cc bag + attached vial was recalled for "particulate matter in the blahblahblah after spiking the bag." This is a pain in the tukas. If you've got 9AM Protonix scheduled, you're darn lucky if the pharmacy runner or tube system gets you the med by 10-11AM. Gotta premix it from "approved" packages, you know!

Good to hear that the FDA is keeping us all "safe" by killing the supply of our common meds. Way to go!