Please be advised the following monographs have been updated on the Drug Monographs page. For IV Parenteral Drug Manual holders, please add/replace/discard as indicated.

REPLACE ADULT Monograph:
Discard the old monograph, PRINT (using the hyperlink) & replace with the new monograph in the Adult Parenteral Drug Monograph Manual as listed below:

Submitted by: Cécile Dumesnil, Manager – Pharmacy
For more info. contact: 204-371-5952 or

CADHAM PROVINCIAL LABORATORY

Beginning January 1, 2025, new cases of syphilis detected by Cadham Provincial Laboratory (CPL) using serologic techniques will no longer be routinely confirmed by Treponema pallidum particle agglutination (TPPA).

All syphilis serologic investigation tends to begin with the CMIA syphilis screen test. As a rule, syphilis cases (beyond the early incubation period) will be positive by CMIA syphilis screen test. All screen test positive individuals will then have syphilis titres checked using the Rapid Plasma Reagin (RPR) test. Most new cases of syphilis have mid- to high RPR titres, and in the past have uniformly confirmed using TPPA. TPPA confirmation will no longer routinely be performed on these types of specimens.

TPPA confirmation will continue to be routinely be performed in the following circumstances:

• CMIA screen positive but RPR negative specimens
• Borderline CMIA positive specimens, regardless of RPR titre

Retrospective studies of recent CPL syphilis serology indicates that these scenarios benefit the most with the addition of TPPA confirmation.

In general terms, there should be little to no impact to clinicians or public health practitioners with this change. If you feel you have a case that requires further investigation with TPPA, please contact CPL or the CPL physician on-call to discuss.

References/Resources:
Please refer to the CPL Guide to Services (G2S) for collection and submission information.

More Information:
CPL G2S website
Manitoba Syphilis Protocol

Contact Information:
Paul Van Caeseele, MD
Medical Director, Cadham Provincial Laboratory | Shared Health
204-945-6456 or email

Submitted by: Loreley Fehr, Manager, Health Services – Public Health-Healthy Living

Overview:

• Production of hydroxocobalamin kits was temporarily suspended due to an investigation into a possible deviation relating to a risk of microbial contamination.
• Lot number 2413, expiry date 30-Oct-2026 was manufactured during this time period and is potentially impacted.
• Based on risk assessment provided by the manufacturer, Health Canada has made the decision to authorize distribution of the affected batch as the risk of microbial contamination is considered minimal.

Note the following guidelines:

• Reserve hydroxocobalamin for patients with clinical signs of acute intoxication in a context suggestive of exposure to cyanide: cardiac arrest, shock, respiratory distress, coma, high lactic acidemia (>8 mmol/L)
• Hydroxocobalamin should not be used in the absence of hypoxia.
• Any signs/symptoms suggestive of systemic infection should trigger blood cultures and antibiotic therapy.

Supply of hydroxocobalamin kit (CYANOKIT) is constrained and conservation measures need to be implemented in order to avoid stock depletion.

Effective immediately: hydroxocobalamin is to be restricted for use in clinical situations requiring antidote for cyanide poisoning. Alternative treatment to consider for vasoplegic syndrome or refractory hypotension is methylene blue at a suggested dose of 1.5 to 2 mg/kg IV administered once over 20 to 60 minutes.

Please not that serotonin syndrome may occur in patients taking serotonergic agents and concomitant use of methylene blue.

Thank you for your support of the ongoing efforts to manage drug supply issues.

For questions, please contact your site pharmacy or please contact Rizwan Ahmed at or Libby Gair at

Submitted by: Pharmacy Program

Supply of dextrose 50% prefilled syringes 50 mL has stabilized in the Canadian market and is freely available. Inventory is sufficient to use without restriction.

Thank you for your support of the ongoing efforts to manage drug supply issues.

For questions, please contact your site pharmacy or please contact Rizwan Ahmed at or Libby Gair at

Submitted by: Pharmacy Program

The medications listed below that have been approved by P&T for addition to our formulary. The paper manual is only updated annually. Please print memo and add to the front of your manuals.

1. carboxymethylcellulose 1% (non-contract) to 0.5% (on contract) eye drops
2. hexylresorcinol (Bradasol) to dequalinium (Dequadin) throat lozenges
3. potassium phosphate 15 mmol/250ml D5W & 30 mmol/500mL D5W
4. meperidine restrictions:
   • The prevention and treatment of drug-induced or blood product-induced rigors (e.g., amphotericin B, platelets),
   • Treatment of post-operative shivering, and
   • Short-term pain management in individuals with normal renal, hepatic and CNS function where alterna-tive opioids are contraindicated (e.g., allergy), and
     • do not exceed 600 mg/24 hours
     • limit the duration of use to 48 hours
5. Combivent Respimat
6. Spiriva Respimat
7. Advair/Wixela Diskus

Submitted by: Pharmacy Program
For more info. contact: Cécile Dumesnil 204-371-5952 or

Please share with all applicable staff.

Please note: This change is for IFTs from facilities in rural and northern Manitoba. The process within the WRHA remains status quo.

A new webform is now available for submitting requests for Inter-Facility Transports (IFTs) through the Virtual Emergency Care and Transfer Resource Service (VECTRS).

Up until now sending health facilities have only able to request IFTs 24 hours in advance. Since November 5, 2024, when VECTRS assumed the responsibility for the triage and prioritization of IFTs, it has become apparent a change is required to improve the utilization of ambulances and stretcher services, to reduce the number of cancelled or rescheduled appointments, and to reduce the need to call (and often wait) to request IFTs.

What is Happening?
To mitigate those challenges, a webform has been created that will enable IFTs to be requested greater than 24 hours in advance of the scheduled appointment where the transport requires a ground ambulance, air ambulance or stretcher transport service. All patients must be medically stable.

The form is located on the VECTRS web page.

We anticipate this form will make the process easier for sending facilities who will now be able to request IFTs further in advance, allowing for better management of expected workloads, a reduction in the amount of calls and fewer last-minute cancelations of appointments which negatively impact patient care.

We anticipate this form will make the process easier for sending facilities who will now be able to request IFTs further in advance, allowing for better management of expected workloads, a reduction in the amount of calls and fewer last-minute cancelations of appointments which negatively impact patient care.

The process for same-day or unstable patients has not changed – call VECTRS 204-949-4000 to request the IFT.

We greatly appreciate your support in facilitating this change. We appreciate the timing directly before the holidays may not be ideal however we feel this is an important, value-added service that will help sites over the holiday season and beyond.

Thank you to Digital Shared Services for their work in helping create the webform and finalizing it this past week.

Any questions regarding the webform or any other VECTRS related questions (not patient care related questions):

Rob Grierson, Chief Medical Officer, Shared Health Emergency Response Services, Michelle Piwniuk, Executive Director, Specialty Services & Coordination, Shared Health Emergency Response Services

For Manitoba clinical & public health practitioners & other Relevant care providers

Beginning Jan 1, 2025, new cases of syphilis detected by the Cadham Provincial Laboratory (CPL) using serologic techniques will no longer be routinely confirmed by Treponema pallidum particle agglutination (TTPA).

All syphilis serologic investigation tends to begin with the CMIA syphilis screen test. As a rule, syphilis cases (beyond the early incubation period) will be positive by CMIA syphilis screen test. All screen test positive individuals will then have syphilis titres checked using the Rapid Plasma Reagin (RPR) test. Most new cases of syphilis have mid- to high RPR titres, and in the past have uniformly confirmed using TPPA. TPPA confirmation will no longer routinely be performed on these types of specimens.

TPPA confirmation will continue to be routinely be performed in the following circumstances:

• CMIA screen positive but RPR negative specimens
• Borderline CMIA positive specimens, regardless of RPR titre

Retrospective studies of recent CPL syphilis serology indicates that these scenarios benefit the most with the addition of TPPA confirmation.

In general terms, there should be little to no impact to clinicians or public health practitioners with this change. If you feel you have a case that requires further investigation with TPPA, please contact CPL or the CPL physician on-call to discuss.

References/Resources:
Please refer to the CPL Guide to Services (G2S) for collection and submission information.

More info.

CPL G2S website
Manitoba Syphilis Protocol

Contact

Paul Van Caeseele, MD, Medical Director, Cadham Provincial Laboratory | Shared Health

204-845-6456 or

There are regional and provincial reports of a clinical practice issue with B.Braun blood administration intravenous (IV) tubing (product #363419, SH-SS SKU 01358) and not being able to puncture through the ports on units of packed red blood cells (PRBCs), resulting in wasted units of blood.

Shared Health Provincial Patient Safety, Shared Health Blood Management and Canadian Blood Services are working on a solution to the issue. Until a solution is available, clinical direction is to continue using B.Braun blood administration IV tubing sets and that units of blood should be placed on a flat surface and punctured using a rotating 10 to 2 wrist motion. Staff are requested to document and report all product issues and blood wastage to assist with the tracking and analysis of the issue. Staff are encouraged to discuss any questions and concerns with their manager/supervisor.

Submitted by: Tamara Burnham, Collaborative Practice Lead
For more information contact: Tim at 431-356-0217 or

For all health care providers and other relevant individuals – access update to guidance on Invasive Meningococcal Disease (IMD) vaccine/catch-up program for children.

Contact Angela Peck, Manitoba Health with any updates to your email, fax or contact name.