title: Innovative approach to preparing radial artery cocktails in response to manufacturer shortages of nitroglycerin and verapamil.
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%.
  
  
  CONCLUSIONS
  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.affiliation: Clinical Assistant Professor, College of Pharmacy, The Ohio State University Wexner Medical Center , Columbus, Ohio.
authors.forename: Rupal K
authors.initials: RK
authors.lastname: Parbhoo
authors.affiliation: Compounding Pharmacist, Department of Pharmacy, The Ohio State University Wexner Medical Center , Columbus, Ohio.
authors.forename: Karen
authors.initials: K
authors.lastname: Wetz
authors.affiliation: Drug Information Specialist, Department of Pharmacy, The Ohio State University Wexner Medical Center , Columbus, Ohio.
authors.forename: Marva
authors.initials: M
authors.lastname: Tschampel
authors.affiliation: 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.
authors.forename: Vincent
authors.initials: V
authors.lastname: Pompili
authors.affiliation: Pharmacy Technician, Department of Pharmacy, The Ohio State University Wexner Medical Center , Columbus, Ohio.
authors.forename: Elena
authors.initials: E
authors.lastname: Schenko
authors.affiliation: Staff Pharmacist, Department of Pharmacy, The Ohio State University Wexner Medical Center , Columbus, Ohio.
authors.forename: Lou
authors.initials: L
authors.lastname: Mavko
authors.affiliation: Clinical Pharmacist, Department of Pharmacy, The Ohio State University Wexner Medical Center , Columbus, Ohio.
authors.forename: Danielle
authors.initials: D
authors.lastname: Blais
keywords: cardiac catheterization; drug shortage; nitroglycerin; radial artery spasm; stability; transradial; verapamil