Rupal K Parbhoo1, Karen Wetz2, Marva Tschampel3, Vincent Pompili4, Elena Schenko5, Lou Mavko6, Danielle Blais7. 1. Clinical Assistant Professor, College of Pharmacy, The Ohio State University Wexner Medical Center , Columbus, Ohio. 2. Compounding Pharmacist, Department of Pharmacy, The Ohio State University Wexner Medical Center , Columbus, Ohio. 3. Drug Information Specialist, Department of Pharmacy, The Ohio State University Wexner Medical Center , Columbus, Ohio. 4. Professor of Internal Medicine, Director of Interventional Medicine and Cardiac Catheterization Laboratories, Director of Cardiovascular Cell-Based Therapies, The Ohio State University Wexner Medical Center , Columbus, Ohio. 5. Pharmacy Technician, Department of Pharmacy, The Ohio State University Wexner Medical Center , Columbus, Ohio. 6. Staff Pharmacist, Department of Pharmacy, The Ohio State University Wexner Medical Center , Columbus, Ohio. 7. Clinical Pharmacist, Department of Pharmacy, The Ohio State University Wexner Medical Center , Columbus, Ohio.
Abstract
BACKGROUND: Transradial access has gained popularity over transfemoral access for cardiac catheterization, because of the decreased risk of bleeding, time to ambulation, and length of stay leading to improved patient satisfaction. One disadvantage of the radial artery approach is vasospasm, which can be prevented with the administration of verapamil and nitroglycerin in a pre- and postradial cocktail. Unfortunately, there have been manufacturer shortages for both of these medications. METHODS: The utilization of radial artery cocktails and other nitroglycerin compounding practices were evaluated in response to cost containment and waste reduction initiatives and to medication shortages. RESULTS: A modified process for supplying verapamil and nitroglycerin for the transradial approach via separate syringes enabled physicians to have quick access to the medications and to customize the cocktail based on the patient's needs. This process also decreased costs and minimized wastage. The change in practice decreased waste from 44% for preradial cocktail syringes and 66% for postradial cocktail syringes to 8.7%. DISCUSSION: This process for supplying the medications necessary to perform a radial artery catheterization and intracoronary nitroglycerin has allowed for conservation of commercial product supply.
BACKGROUND: Transradial access has gained popularity over transfemoral access for cardiac catheterization, because of the decreased risk of bleeding, time to ambulation, and length of stay leading to improved patient satisfaction. One disadvantage of the radial artery approach is vasospasm, which can be prevented with the administration of verapamil and nitroglycerin in a pre- and postradial cocktail. Unfortunately, there have been manufacturer shortages for both of these medications. METHODS: The utilization of radial artery cocktails and other nitroglycerin compounding practices were evaluated in response to cost containment and waste reduction initiatives and to medication shortages. RESULTS: A modified process for supplying verapamil and nitroglycerin for the transradial approach via separate syringes enabled physicians to have quick access to the medications and to customize the cocktail based on the patient's needs. This process also decreased costs and minimized wastage. The change in practice decreased waste from 44% for preradial cocktail syringes and 66% for postradial cocktail syringes to 8.7%. DISCUSSION: This process for supplying the medications necessary to perform a radial artery catheterization and intracoronary nitroglycerin has allowed for conservation of commercial product supply.
Authors: Ferdinand Kiemeneij; Bhavesh U Vajifdar; Simon C Eccleshall; GertJan Laarman; Ton Slagboom; Ron van der Wieken Journal: Catheter Cardiovasc Interv Date: 2003-03 Impact factor: 2.692