American Society of Regional Anesthesia and Pain Medicine contrast shortage position statement

Abstract

The medical field has been experiencing numerous drug shortages in recent years. The most recent shortage to impact the field of interventional pain medicine is that of iodinated contrast medium. Pain physicians must adapt to these changes while maintaining quality of care. This position statement offers guidance on adapting to the shortage.

Metrics-driven successful strategy by emergency and radiology driven task force to mitigate global CT contrast media shortage in a safety net hospital

“…ACR recommends repackaging single-use vials into multiple-use ones to prevent contrast wastage. [ 21 ] Our pharmacy assisted in repackaging smaller aliquots following the International Organization for Standardization class 5 rooms regulation; [ 22 ] these aliquots were primarily used for joint injection and surgical procedures.…”

Optimizing the Use of Iodinated Contrast Media for CT: Managing Shortages and Planning for a Sustainable and Secure Supply

“…For example, using CT without contrast or alternative imaging modalities that do not require ICM, such as ultrasound, MRI, and nuclear medicine, may be appropriate in some circumstances. 1,4,[7][8][9]13,16,19,21,[24][25][26][27]33,[38][39][40][41] If possible, alternative brands of contrast agents from other vendors could be purchased in some instances to help mitigate ICM shortages. 13,17,25,33 Examples of alternate contrast agents may include oral contrast (such as barium sulphate or diatrizoate meglumine and diatrizoate sodium [Gastrografin, Cystografin, Sinografin]) or, if appropriate, carbon dioxide angiography for peripheral artery disease, MRI with gadolinium contrast, or ethiodized oil (Lipiodol, Guerbet).…”

“…5,9,13,14,16, 19,21,25,38,42 Procedures may be stratified based on risk to determine which may be safely deferred until normal ICM supplies resume (for example, routine follow-up exams). 5,7,13,16,19,21,24, [26][27][28]34 At Monash Health in Australia, for example, a tier system identified conditions in which contrast-enhanced CT was necessary (tier 1), CT without contrast was sufficient (tier 2), alternate types of imaging could be used (tier 3), and imaging could be postponed (tier 4). 4 Optimizing ICM Dose…”

“…In some circumstances, ICM doses may be reduced if image quality is still adequate. 6,7,9,13,17,19,27,38,40 Two examples include tailoring ICM doses to the patient's body weight 1,5,9,16,17,24,25,33,43 and updating dosing protocols for ICM (i.e., reduced) to reflect newer generations of CT scanners. 4 Moreover, waste of ICM may be minimized by: 1,7,9,13,16,17,21,24,25,33,37-39…”

“…To avoid contamination and risk to patients, this should be performed by a trained health care professional (i.e., pharmacist or under the supervision of a pharmacist), following established protocols for sterile procedures. 5,13,21,25,26,44 Of note, this strategy was also suggested by GE Healthcare (i.e., repackaging of larger vials into smaller, single-use preparations, if necessary). 45…”