Vasopressin removed from code trays
Updated AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care include a modified recommendation for use of vasopressors in cardiac arrest.
The updated recommendation indicates that standard-dose epinephrine (1 mg every three to five minutes) may be reasonable for patients in cardiac arrest. According to cited evidence, vasopressin, used alone or in combination with epinephrine, offers no advantage for these patients, and thus vasopressin has been removed from the ACLS algorithm.
The currently available formulation of vasopressin requires refrigeration. Once removed from the refrigerator, vials may be held for up to 12 months, which influences the expiration of the code tray and likely requires greater frequency of code tray exchange.
Due to the changes in the ACLS guidelines and limitations of the current vasopressin formulation, the P&T Committee has approved the removal of vasopressin from code trays. It will be made available by the pharmacy if needed.
Limit utilization of fentanyl and hydromorphone PCAs due to syringe shortage
A shortage of PCA syringes limits the pharmacy’s ability to provide compounded fentanyl and hydromorphone. The shortage is expected to last until at least April.
As a result, we request that providers limit utilization of fentanyl and hydromorphone PCAs to patients with documented allergy/intolerance to morphine.
If the pharmacy receives an order for fentanyl or hydromorphone PCA without clearly documented morphine allergy, per P&T, it will automatically be interchanged to an equianalgesic dose of morphine, as those premanufactured PCA syringes are readily available. Dialysis patients will be excluded from this interchange.
If you have any questions, please contact Jim Kennel, Manager of Drug Use Policy and Outcomes, 544-4057.