Thursday, July 28, 2022

Supply-chain issues cause shortage of epidural supplies in western Canada

Epidurals are injected into patients' backs, and are most commonly administered to pregnant women during labour and delivery

Author of the article:Jason Herring
Publishing date:Jul 25, 2022 • 

A patient receives an an anaesthetic prior to an epidural at an Ottawa hospital. 

Alberta is among provinces facing a shortage of epidural supplies which could lead to some patients receiving alternative treatment.

The province’s health authority says the crunch is the product of global supply chain challenges, with epidural catheters and tubing impacted.

“In terms of Alberta, we currently have more than two weeks’ worth of supply, and there is no imminent impact on patients,” said Alberta Health Services spokesperson Kerry Williamson.

“Given this international shortage, AHS is considering safe alterations of practice to ensure patients receive an appropriate alternative and will support the continued availability of supply where no clinically appropriate alternative can be used.”

AHS explained the epidural catheters are used for obstetrical care alongside general anesthesia to relieve pain during and after operations.

Epidurals are injected into patients’ backs, and are most commonly administered to pregnant women during labour and delivery.

The supply shortage has impacted hospitals in British Columbia, Saskatchewan and Manitoba, according to Health Canada. The federal department said in a statement to Postmedia the provinces “are experiencing varying degrees of constrained supplies.”


Health Canada said it is working with with hospitals, health authorities and manufacturers to learn more about epidural catheter supply to determine whether there is a national shortage.

“If the shortage is confirmed to be of national scope, Health Canada will take action if needed to help mitigate the impact of the shortage on patients, which may include exploring access to international supply, if possible,” the statement read.

Under Health Canada regulations introduced in March 2020, medical device manufacturers and importers are required to report shortages of select devices to the federal department.

Williamson said though there is epidural supply for the immediate future, AHS is actively working to fortify its stock.

“We are working with our vendors to have urgent shipments sent as soon as possible and are investigating whether alternate supplies we have in stock may be used,” he said.

“AHS will monitor the situation closely and will work with patients directly to discuss options as required.”

This isn’t the first time in recent months supply-chain strain has led to supply scarcity in Alberta’s health system.

Earlier this year, Albertans faced reduced access to blood testing as a shortage of blood collection tubes put pressure on the province’s public labs.

Global shortage of epidural tubes hits Western Canada, has Ontario hospitals on alert

A global shortage of the tubes, used mainly to deliver pain relief during labour and delivery, has hit four western provinces.
THE STAR
Staff Reporter
Tue., July 26, 2022

A global shortage of epidural tubes, used mainly to deliver pain relief during labour and delivery, has hit four western provinces and has some Ontario hospitals on alert, including in Toronto and Hamilton.

Epidurals are administered through a shot to the spine, and numb the bottom half of the body.

There are other ways to manage pain during birth, such as opioids or laughing gas, but the epidural is considered the “gold standard” both in terms of pain relief and safety, says Dr. Dolores McKeen, the president of the Canadian Anesthesiologists’ Society.

“It’s certainly not desirable for any patient who may be denied what we consider as gold standard,” she said.

Health Canada spokesperson Tammy Jarbeau said in an email that Alberta, Manitoba, Saskatchewan and British Columbia “are experiencing varying degrees of constrained supplies.”

Health Canada is working with provinces and territories “to gather information regarding current supplies of epidural catheters in Canada and to determine whether there is a national shortage.” If it is confirmed, it will “take action if needed to help mitigate the impact of the shortage on patients, which may include exploring access to international supply, if possible.”

In the midst of this shortage, the Saskatchewan Health Authority put out a statement last week, warning that it may impact patients and asking them to review other pain-management options. The Health Authority has also issued triage guidelines, on how to prioritize the highest-risk patients, given the limited supply.

None of the Ontario hospitals the Star surveyed reported limiting or triaging epidurals, but the shortage is something they’re paying close attention to.

No patients have been affected at Unity Health, the hospital network that includes St. Joseph’s and St. Michael’s in Toronto, and patients will continue to get epidurals when needed. But they “should know that “we are working with our anesthetists and suppliers to explore product options in the event the availability changes, and that we continue to monitor the situation closely,” said spokesperson Jennifer Stranges in an email.

A memo from Hamilton Health Sciences leaders to Labour and Delivery and Surgical Teams, sent Friday, noted that some provinces are reporting low supplies of the tube used to deliver pain relief during birth and for some other types of surgery.

“At this time, we have not experienced low supplies in Ontario, however, this is likely to change,” the memo noted.

“Currently, we have sufficient supplies to continue to meet the needs of patients in the short term,” the memo added. But hospital leaders are working with procurement “to secure alternative vendors” and “stabilize” longer-term supplies.

Kingston Health Sciences Centre is also monitoring the shortage and although not limiting procedures at this time, it is “preparing contingency plans should this become a long-lasting shortage,” a spokesperson said in an emailed statement. London Health Sciences Centre is working to “find supply alternatives,” but so far no patients have been affected, a spokesperson confirmed.

According to a report from the Canadian Institute for Health Information, epidurals were used in 59 per cent of vaginal deliveries in 2017-2018.

Epidurals are often used in high-risk pregnancies, in the case of twins, for example, and allow a medical team to quickly pivot to an emergency Caesarean section, if needed, without putting the mom to sleep, added McKeen, who is also a professor of anesthesia at Memorial University, and an obstetrical anesthesiologist.

“So it’s actually a safety strategy that we sometimes will use, particularly if we think a woman is at risk of going to the operating room,” she said. The Canadian Anesthesiologists’ Society has been hearing reports from various regions of changes in the supply for the past few months, but the situation has become more urgent, with some providers out west starting to run short of epidural catheters and kits, she said.

McKeen said they suspect the root of the shortage is “definitely supply chain, most likely fallout from COVID.”

It’s not the first medical essential to be affected by global supply chain shortages. This winter, Ontario hospitals faced a critical shortage of collection tubes required for routine blood work.

Three hospitals in Waterloo region, as reported by the Star’s sister paper The Record last week, still have the supplies in stock, but are working together to “develop a plan to manage next steps,” according to a statement posted on the Grand River Hospital website.

“We are investigating the procurement of substitute options, should they be needed,” the statement added.

May Warren is a Toronto-based breaking news reporter for the Star. Follow her on Twitter: @maywarren11


Ontario monitoring epidural shortage in Western Canada, hospitals making plans

By Caryn Lieberman Global News
Posted July 27, 2022

Health officials in Ontario are monitoring a global shortage of epidural supplies and obstetric patients may be paying particular attention as well. Caryn Lieberman reports.


When Shaneeza Shaw planned for the birth of her first baby, she had hoped for an unmedicated delivery, but baby Jaylen had other plans.

“Initially labour went fine and then I started getting a lot more pain,” recalled the new mother.

“My initial plan was not to take the epidural, but I ended up getting the epidural because at that point I knew I couldn’t handle it anymore,” she said.

Shaw ended up having an emergency C-section Tuesday morning and gave birth to a healthy baby boy.

Dr. Lesley Hawkins, obstetrician and gynaecologist at Humber River Hospital, said an epidural is “one of the most popular choices for pain management in labour.”


READ MORE: Prepare for shortage of epidural catheter kits for pain management during childbirth: SHA

There are concerns right now in Canada and around the world due to a worldwide shortage of epidural kits used to treat pain in childbirth, but also for pain relief during or after various surgical procedures.

“An epidural is part of really multi-modal options for pain management in labour and the discussion about an epidural happens throughout the entire pregnancy with the patient’s provider, whether that’s an OBGYN like me, a family physician or a midwife … and it is absolutely a patient’s choice,” said Hawkins.

The Ontario Ministry of Health is watching the situation unfold in other Canadian provinces where there are shortages in the availability of epidural catheters due to supply chain issues.

“Currently, Ontario has an adequate supply of epidural catheters and women are able to access epidurals for childbirth. The Ministry of Health and Ontario Health are actively engaging with Health Canada, suppliers, distributors and manufacturers across Ontario to understand the current situation and supply forecasts in order to mitigate any potential impact to patients,” a spokesperson for the ministry told Global News in a statement.

The shortage is due to a supply chain issue from one component of the epidural catheter kit.

READ MORE: Expectant parents bracing for epidural shortage in Saskatchewan

“An epidural is a great mode of analgesia, one of many different options for pain management in labour and it really helps with the discomfort and the pain that happen during labour and delivery,” explained Hawkins.

“It certainly is something that is on all of our minds and it is a concern,” she added.

From Seed to Sprout, a perinatal organization based in Saskatchewan, is hoping to inform expectant parents about other methods that can be used for pain management in labour.

“We like to talk about it in terms of tools in your toolbox. So an epidural is one of the tools in your toolbox, and it’s the most commonly thought of tool in your toolbox, but it’s just one of them. So the very first tool that every pregnant person should have in their toolbox is education and education about the labour process, about birthing, about the norms, the expectations,” explained registered nurse and co-owner of From Seed to Sprout, Loreli Palandri.

She listed a number of alternative options to an epidural that can help with pain management, like baths and showers during labour.

“You actually can decrease the sensations that contractions give you because the water kind of changes your buoyancy and the gravitational pull on you so it literally changes the sensations that you will feel. You can also enlist your support people … we know that having continuous support during labour and birth is also proven to make you feel better,” said Palandri.

READ MORE: Alberta Health Services taking action over shortage of epidural catheters

In a statement, Health Canada told Global News that it “has engaged with provincial and territorial (PT) health authorities, hospitals and manufacturers to gather information regarding current supplies of epidural catheters in Canada and to determine whether there is a national shortage.”

Preliminary information indicates that “the provinces of Alberta, Manitoba, Saskatchewan and British Columbia are experiencing varying degrees of constrained supplies.”

“It is a concern but something that our team is working really hard on,” said Hawkins.

“Our team is working really hard from our leadership to the physicians and other health-care providers on our team for a shortage should it happen.”

Hawkins also pointed out there are other options to consider during labour.

“For example, nitrous oxide or other pain medications to help with labour pain management and then there is all the non-medication options as well that we’re employing, like using the birthing ball, a warm bathtub, different mobility exercise, all sorts of things that we use for pain management in labour.”

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