Peter Antevy discusses shortages of critical medical supplies like gentamicin, IV catheters, and epinephrine, and shares techniques for adapting when these drugs aren't available.
Hello, everybody. I want to take a few minutes of your time and I want to explain a couple things that we've been dealing with here in the medical services division that ultimately has been affecting you and your service delivery in the streets. As you know, there's been some supply chain issues when it comes to medical supplies throughout the department. And that's not just here in the department, it's also nationally and internationally. So in an effort to keep you informed of what's going on, we have been continually communicating through the EMS captain rank. And anytime we anticipate any shortage of medications, I would like to take a few minutes to mention a couple of things that you're definitely going to need to know because this is going to drastically affect how we deliver certain medications in the near future. So the first thing I want to mention is gentamicin. Unfortunately, there is a shortage of vials actually for gentamicin. It has nothing to do with the medication itself. It's the actual containers. So the issue that we're dealing with right now is we are unable to get gentamicin in the concentration that we're accustomed to be using. Go ahead and use what you have in supply. If you don't have it, you're not going to give it. But as soon as gentamicin becomes available, we're going to continue to administer that drug as before. That doesn't mean that we're not going to also give rocephin. We're going to continue to give rocephin in any patient where it's indicated. It's just the gentamicin we do not have available. And we are anticipating this is going to be coming back in stock sooner than later. So we're not going to make any changes because of that reason. The second thing I want to make mention of is the IV catheters. And we've had several different IV catheters that we've had to introduce over the last few months due to the supply chain issues. And if you remember several years ago, whenever you would place an IV into patient's arm, as soon as you withdrew the needle, the patient would begin to bleed because there wasn't that one way check valve. Since I would say about three to four years ago, we actually implemented a new needle which is called the via valve and it has a one way valve so that whenever you did access the vein and it did not bleed, it didn't. You didn't have to tampon on the vein anymore in order to prevent the patient from bleeding. One of the things that we've had to deal with is we've had to go back to the original catheter that we've used for so long in sizes 14, 16, and 18, because the one way via valves are not available. And so what's happening is a lot of crews in the field are not accustomed to this. And as they remove the needle from the patient's arm, the patient begins to bleed. So I want to make you aware of this as we look at the needles. When you open them up, the 14s, the 16s, and the 18s, you may have one with a via valve. You may not go ahead and read the package. And if you look at the package, it's going to say very clearly that this IV catheter has that via valve in it. And that's going to prevent the patient from bleeding whenever you pull the needle out. If it does not have that, this patient will bleed as soon as the needle comes out. And you're going to have to tamponade that patient's vein in order to prevent that from happening. So we're actually going to take a few minutes and I'm going to show you exactly what I'm talking about. So just to demonstrate this, so if you look on the package right here, it says via valve very clearly. This is the protect IV that we've had to return back to this type, this style of iv. So we're going to go ahead and open this up and I'm going to show you what this looks like on the inside. So let me go ahead and show you the way that the via valve works. But again, inside this hub, there is a one way valve that keeps the blood from coming out whenever you access the picture patient. And so if I were to open up this package right here, that is the traditional protect IV without the one way valve, again, it's going to be very difficult. You're not going to be able to see that difference in the catheter itself from the outside, with the exception of that one way valve that's going to be in this one. So you're going to have to pay close attention to the packaging and look for that sign. If it does not say a via valve, it does not have that one way valve. Let me go ahead and show you what we're supposed to do, show you the technique.
For using the protect iv. So I'm going to borrow my trusty sidekick's arm right here, and I wanted to make sure that everybody understands the traditional technique when it comes to inserting an IV catheter and where we're supposed to be placing this catheter, where we're supposed to tamponade this patient. So let's say the catheter is inserted right about right here. And as you can clearly see, this would be the insertion site. The catheter is going to go in to the distance that's described on the package. In this case, it would be an inch and one quarter is the length of this. So when the needle retracts, it's going to continue to pour blood out especially. So you're going to have to do a couple of things. You're going to have to tamponade the vein just past the catheter. Take these two fingers and hold the hub. Go ahead and pop that tourniquet so that it reduces the pressure. And then we'll connect.
Our IV tubing and then secure the iv. But again, if you do not tamponade the vein proximal to that catheter, it will bleed and it will leak blood all over the patient. Support services is continuing to receive sporadic shipments of the via valve catheters. So the best advice is to pay close attention to the packaging and adapt your technique accordingly. When we finally return to normal inventory, we're going to remove the protect IV and only have the via valve in supply. So the last drug we're going to talk about today is epinephrine. There has been some issues lately with the cardiac dose of epi, that 1 in 10,000 epinephrine, and we're not going to be able to get that for an extended period of time. So this is going to cause us to have to change the way that we not just administer the drug, but the way that we prepare the drug for administration. And in another video, I'm going to give you a step by step tutorial on how to put that together. But in the meantime, I hope that you stay safe. Thank you for all that you do and we definitely appreciate your work. We appreciate all that you're doing throughout this COVID 19 pandemic and the way that you keep persevering, the way you keep running calls, and the way you keep doing the right thing. Thank you so much for all you do and we look forward to serving you in the future. Thank you.
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