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Perfusion NewswireMain ZoneShortage: Sodium Chloride 0.9% Injection Bags

Shortage: Sodium Chloride 0.9% Injection Bags

Main Zone, Mobile Zone, Perfusion Zone, Warnings and Recalls

Products Affected – Description

Sodium Chloride 0.9%, Baxter
150 mL bag (NDC 00338-0049-01)
250 mL bag (NDC 00338-0049-02)
500 mL bag (NDC 00338-0049-03)
500 mL bag, PVC/DEHP-free (NDC 00338-6304-03)
250 mL bag, PVC/DEHP-free (NDC 00338-6304-02)
1000 mL bag (NDC 00338-0049-04)
 
Sodium Chloride 0.9%, BBraun
250 mL bag, PVC/DEHP-free (NDC 00264-7800-20)
500 mL bag, PVC/DEHP-free (NDC 00264-7800-10)
1000 mL bag, PVC/DEHP-free (NDC 00264-7800-00)

Sodium Chloride 0.9%, Hospira

150 mL bag (NDC 00409-7983-61)
500 mL bag, PVC/DEHP-free (NDC 00409-7983-30) – discontinued
1000 mL bag, PVC/DEHP-free (NDC 00409-7983-48) – discontinued

250 mL bag, PVC/DEHP-free (NDC 00409-7983-25)

Reason for the Shortage


  • Baxter has sodium chloride 0.9% on shortage due to increased demand.1
  • BBraun had sodium chloride 0.9% on allocation due to increased demand.2
  • Hospira cites increased demand as the reason for the shortage.3

Available Products


Sodium Chloride 0.9%, Hospira (allocated for current customers)

250 mL bag (NDC 00409-7983-02)
500 mL bag (NDC 00409-7983-03) 
250 mL bag (2 ports) (NDC 00409-7983-53)  
500 mL bag (2 ports) (NDC 00409-7983-55)
1000 mL bag (NDC 00409-7983-09)

Estimated Resupply Dates


  • Baxter has all sodium chloride 0.9% injection presentations on allocation.1
  • BBraun is allocating all sodium chloride 0.9% PVC/DEHP-free bags.2
  • Hospira has sodium chloride 0.9% 250 mL bags PVC/DEHP-free
    on back order with an estimated release date of mid-February 2014. The
    150 mL bags are on back order and the company estimates a release date
    of late-January 2014.3

Implications for Patient Care


Sodium chloride injection is widely used for a variety of indications.4 While many products are in short supply, the product most affected is the 1,000 mL bags of sodium chloride.1-3 As this shortage worsens, other solutions such as lactated ringers may be affected.

Safety


  • Clinicians may need to utilize different product sizes if large bags are not available. More frequent bag changes may be needed.
  • Compounding sodium chloride solutions from sterile water
    for injection and concentrated sodium chloride injection could lead to
    medication errors and inadvertent administration of plain sterile water,
    and contribute to current shortages of concentrated sodium chloride
    injection (23.4% or 14.6%).
  • Multiple brands of products may be available in the system.
  • Avoid use of irrigation solution for intravenous use.
    Sterility requirements and limits on particulate matter differ between
    these two products.1-3,5-7

Alternative Agents & Management


  • Consider using oral hydration whenever possible.
  • Consider using commercial dialysis solutions whenever possible.
  • Use smaller bag sizes for low rate infusions when possible.
    See the Table for suggestions. Use smaller bags and low flow rates as
    sodium chloride 0.9% is often used to keep an intravenous line open.
  • Switch products to match availability. Consider using
    alternative fluids such as dextrose containing solutions or lower
    concentrations of sodium chloride that may be available (0.45%). 
     

Table. Suggested Bag Sizes for Specific Rates of Infusion

Infusion Rate

Bag Size

20 mL / hour or less 

250 mL

21 mL/hour to 40 mL/hour

500 mL

Related Shortages


References


  1. Baxter (personal communications). January 29, February 4, March
    14, April 17, May 15, June 13, July 2, August 8, September 18, October
    15, November 13, December 5, 2013; and January 13, 15, and 16, 2014.
  2. BBraun (personal communications). January 29, February 4,
    March 14, April 17, May 15, June 13, July 2, September 9, October 15,
    November 18, December 5, 2013; and January 16, 2014.
  3. Hospira (personal communications and website). January 29,
    February 4, March 14 and 21, April 17, May 15, June 13, July 2 and 11,
    September 12 and 18, October 15, November 18, December 5 and 16, 2013;
    and January 14 and 16, 2014.
  4. McEvoy GK, Snow EK, Kester L, Litvak K, Miller J, Welsh OH,
    eds. AHFS DI (Lexi-Comp Online). Bethesda, MD: American Society of
    Health-System Pharmacists; 2014.
  5. <1> Injections. In: The United States Pharmacopeia,
    35th revision. Rockville, MD: The United States Pharmacopeial
    Convention; 2012: 33-37.
  6. <71> Sterility tests. In: The United States
    Pharmacopeia, 35th revision. Rockville, MD: The United States
    Pharmacopeial Convention; 2012: 69-74.
  7. <788> Particulate matter in injections. In: The
    United States Pharmacopeia, 35th revision. Rockville, MD: The United
    States Pharmacopeial Convention; 2012: 339-342.

Updated


Created January
16, 2014 by Erin R. Fox, PharmD, FASHP, Director of Drug Information and
Michelle M Wheeler, PharmD, Drug Information Specialist, University of
Utah, Drug Information Service. Copyright 2014, Drug Information
Service, University of Utah, Salt Lake City, UT.

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