2018 - 2019 Plastic Surgery Essentials Buying - 23

0.9 % Sodium Chloride Injection, USP
in FLEBOFLEX Plastic Container

This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in
patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should
be taken in dose selection, and it may be useful to monitor renal function.

DESCRIPTION
Sodium Chloride Injection, USP is a sterile, nonpyrogenic solution for fluid and electrolyte replenishment in single dose
containers for intravenous administration. It contains no antimicrobial agents. The pH ranges from 4.5 to 7.0.
0.9% Sodium Chloride Injection, USP contains 9 g/L Sodium Chloride, USP (NaCl) with an osmolarity of 308 mOsmol/L (calc).
It contains 154 mEq/L sodium and 154 mEq/L chloride.
The FLEBOFLEX plastic container is fabricated from latex-free polyolefins or polypropylene plastic materials. The solution
contact materials do not contain PVC, DEHP, or other plasticizers. The amount of water that can permeate from inside the
container into the overwrap is insufficient to affect the solution significantly. The suitability of the container materials has
been established through biological evaluations, which have shown the container passes Class VI U.S. Pharmacopeia (USP)
testing for plastic containers. These tests confirm the biological safety of the container system.

ADVERSE REACTIONS
Post-Marketing Adverse Reactions
The following adverse reactions have been identified during postapproval use of Sodium Chloride Injection, USP. Because
these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their
frequency or establish a causal relationship to drug exposure.
The following adverse reactions have been reported in the post-marketing experience during use of 0.9% Sodium Chloride
Injection, USP and include the following: hypersensitivity/ infusion reactions, including hypotension, pyrexia, tremor, chills,
urticaria, rash, and pruritus.
Also reported are infusion site reactions, such as infusion site erythema, injection site streaking, burning sensation, and
infusion site urticaria.
The following adverse reactions have not been reported with 0.9% Sodium Chloride Injection, USP but may occur: hypernatremia, hyperchloremic metabolic acidosis, and hyponatremia, which may be symptomatic.
Hyponatremia has been reported for 0.45% Sodium Chloride Injection, USP (see Pediatric Use section).
The following adverse reactions have not been reported with 0.45% Sodium Chloride Injection, USP but may occur: hyperchloremic metabolic acidosis, hypersensitivity/infusion reactions (including hypotension, pyrexia, tremor, chills, urticaria,
rash, and pruritus), and infusion site reactions (such as infusion site erythema, injection site streaking, burning sensation,
infusion site urticaria).
If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures and save the remainder of the fluid for examination if deemed necessary.

CLINICAL PHARMACOLOGY
Sodium Chloride Injection, USP has value as a source of water and electrolytes. It is capable of inducing diuresis depending
on the clinical condition of the patient.
INDICATIONS AND USAGE
Sodium Chloride Injection, USP is indicated as a source of water and electrolytes.
0.9% Sodium Chloride Injection, USP is also indicated for use as a priming solution in hemodialysis procedures.
CONTRAINDICATIONS
None known.
WARNINGS
Hypersensitivity/infusion reactions, including hypotension, pyrexia, tremor, chills, urticaria, rash, and pruritus have been
reported with 0.9% Sodium Chloride Injection, USP and may occur with 0.45% Sodium Chloride Injection, USP.
Stop the infusion immediately if signs or symptoms of a hypersensitivity reaction develop, such as tachycardia, chest pain,
dyspnea and flushing. Appropriate therapeutic countermeasures must be instituted as clinically indicated.
Depending on the volume and rate of infusion, the intravenous administration of Sodium Chloride Injection, USP can cause
fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration/hypervolemia, congested states, pulmonary edema, or acid-base imbalance. The risk of dilutive states is inversely proportional to the electrolyte concentration of the injection. The risk of solute overload causing congested states with peripheral and pulmonary
edema is directly proportional to the electrolyte concentrations of the injection.
Monitor changes in fluid balance, electrolyte concentrations, and acid base balance during prolonged parenteral therapy or
whenever the condition of the patient or the rate of administration warrants such evaluation.
Administer 0.9% Sodium Chloride Injection, USP with particular caution, to patients with or at risk for hypernatremia,
hyperchloremia, or metabolic acidosis.
The infusion of solutions with 0.45% Sodium Chloride Injection, USP may result in hyponatremia. Close clinical monitoring
may be warranted. Hyponatremia can lead to headache, nausea, seizures, lethargy, coma, cerebral edema and death. The
risk for hyponatremia is increased, for example, in children, elderly, women, postoperatively, in persons with psychogenic
polydipsia, and in patients treated with medications that increase the risk of hyponatremia (such as certain antiepileptic
and psychotropic medications). The risk for developing hyponatremic encephalopathy is increased, for example, in pediatric
patients ()16 years of age), women (in particular pre-menopausal women), in patients with hypoxemia, and in patients
with underlying central nervous system disease. Acute symptomatic hyponatremic encephalopathy is considered a medical
emergency.
Administer Sodium Chloride Injection, USP with particular caution, to patients with or at risk for hypervolemia or with
conditions that may cause sodium retention, fluid overload and edema; such as patients with primary hyperaldosteronism,
or secondary hyperaldosteronism [e.g., associated with hypertension, congestive heart failure, liver disease (including cirrhosis), renal disease (including renal artery stenosis, nephrosclerosis) or pre-eclampsia]. Certain medications may increase
risk of sodium and fluid retention, see Drug Interactions.
Administer Sodium Chloride Injection, USP with particular caution, to patients with severe renal impairment. In such patients,
administration of Sodium Chloride Injection, USP may result in sodium retention.
PRECAUTIONS
General
Do not connect flexible plastic containers in series in order to avoid air embolism due to possible residual air contained in the
primary container. Such use could result in air embolism due to residual air being drawn from the primary container before
administration of the fluid from the secondary container is completed.
Pressurizing intravenous solutions contained in flexible plastic containers to increase flow rates can result in air embolism if
the residual air in the container is not fully evacuated prior to administration.
Use of a vented intravenous administration set with the vent in the open position could result in air embolism. Vented intravenous administration sets with the vent in the open position should not be used with flexible plastic containers.
Do not mix or administer 0.45% Sodium Chloride Injection, USP through the same administration set with whole blood or
cellular blood components.
Rapid correction of hypo- and hypernatremia is potentially dangerous (risk of serious neurologic complications). Dosage,
rate, and duration of administration should be determined by a physician experienced in intravenous fluid therapy.
Drug Interactions
Caution must be exercised in the administration of Sodium Chloride Injection, USP to patients treated with drugs that may
increase the risk of sodium and fluid retention, such as corticosteroids.
Caution is advised in patients treated with lithium. Renal sodium and lithium clearance may be decreased in the presence of
hyponatremia. Administration of 0.45% Sodium Chloride Injection, USP may result in increased lithium levels.
Renal sodium and lithium clearance may be increased during administration of 0.9% Sodium Chloride Injection, USP. Administration of 0.9% Sodium Chloride Injection, USP, may result in decreased lithium levels.
Pregnancy
Pregnancy Category C
There are no adequate and well controlled studies with Sodium Chloride Injection, USP in pregnant women and animal
reproduction studies have not been conducted with this drug. Therefore, it is not known whether Sodium Chloride Injection,
USP can cause fetal harm when administered to a pregnant woman. Sodium Chloride Injection, USP should be given during
pregnancy only if the potential benefit justifies the potential risk to the fetus.
Nursing Mothers
It is not known whether this drug is present in human milk. Because many drugs are present in human milk, caution should
be exercised when Sodium Chloride Injection, USP is administered to a nursing woman.
Pediatric Use
The use of Sodium Chloride Injection, USP in pediatric patients is based on clinical practice. (See Dosage and Administration).
Plasma electrolyte concentrations should be closely monitored in the pediatric population as this population may have
impaired ability to regulate fluids and electrolytes.
The infusion of hypotonic fluids (0.45% Sodium Chloride Injection, USP) together with the non-osmotic secretion of ADH
may result in hyponatremia in patients with acute volume depletion. Hyponatremia can lead to headache, nausea, seizures,
lethargy, coma, cerebral edema and death, therefore acute symptomatic hyponatremic encephalopathy is considered a
medical emergency.
Geriatric Use
Clinical studies of Sodium Chloride Injection, USP did not include sufficient numbers of subjects aged 65 and over to
determine whether they respond differently from younger subjects. Other reported clinical experience has not identified
differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should
be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal,
or cardiac function, and of concomitant disease or other drug therapy.

18MS8933

OVERDOSAGE
Excessive administration of 0.45% Sodium Chloride Injection, USP may lead to hypo- and hypernatremia, while excessive
administration of 0.9% Sodium Chloride Injection, USP may lead to hypernatremia. Both hypo- and hypernatremia can lead
to CNS manifestations, including seizures, coma, cerebral edema and death.
Excessive administration of Sodium Chloride Injection, USP may lead to sodium overload (which can lead to central and/
or peripheral edema).
When assessing an overdose, any additives in the solution must also be considered. The effects of an overdose may require
immediate medical attention and treatment.
DOSAGE AND ADMINISTRATION
All injections in FLEBOFLEX plastic containers are intended for intravenous administration using sterile and nonpyrogenic
equipment.
As directed by a physician. Dosage, rate, and duration of administration are to be individualized and depend upon the
indication for use, the patient's age, weight, clinical condition, concomitant treatment, and on the patient's clinical and
laboratory response to treatment.
When other electrolytes or medicines are added to this solution, the dosage and the infusion rate will also be dictated by
the dose regimen of the additions.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Use of a final filter is recommended during administration of all parenteral solutions,
where possible.
Do not administer unless the solution is clear and seal is intact.
Additives may be incompatible with Sodium Chloride Injection, USP. As with all parenteral solutions, compatibility of the
additives with the solution must be assessed before addition. Before adding a substance or medication, verify that it is
soluble and/or stable in water and that the pH range of Sodium Chloride Injection, USP is appropriate. After addition, check
for unexpected color changes and/or the appearance of precipitates, insoluble complexes or crystals.
The instructions for use of the medication to be added and other relevant literature must be consulted. Additives known
or determined to be incompatible must not be used. When introducing additives to Sodium Chloride Injection, USP,
aseptic technique must be used. Mix the solution thoroughly when additives have been introduced. Do not store solutions
containing additives.
After opening the container, the contents should be used immediately and should not be stored for a subsequent infusion.
Do not reconnect any partially used containers. Discard any unused portion.
HOW SUPPLIED
The available size of 0.9% Sodium Chloride Injection, USP is shown below:
Size (mL)
NDC
500 (20 units in one carton)
76297-001-01
Exposure of pharmaceutical products to heat should be minimized. Avoid excessive heat. It is recommended the product be stored at 20° to 25°C (68° to 77°F); excursions are permitted between 15° to 30°C (59° to 86°F). [see USP
Controlled Room Temperature.] Store unit in moisture barrier overwrap. Brief exposure up to 40°C (104°F) does not
adversely affect the product.
DIRECTIONS FOR USE OF FLEBOFLEX PLASTIC CONTAINER
For Information on Risk of Air Embolism - see PRECAUTIONS
To Open
Peel off the overwrap and remove solution container. Visually inspect the container. If the outlet port protector is damaged,
detached, or not present, discard container as solution path sterility may be impaired. Some opacity of the plastic due to
moisture absorption during the sterilization process may be observed. This is normal and does not affect the solution quality
or safety. The opacity will diminish gradually. Check for minute leaks by squeezing inner bag firmly. If leaks are found, discard
solution as sterility may be impaired. If supplemental medication is desired, follow directions below.
Preparation for Administration
1. Suspend container from eyelet support.
2. Remove protector from outlet port at bottom of container.
3. Attach administration set. Refer to complete directions accompanying set.
To Add Medication
Additives may be incompatible.
To add medication before solution administration
1. Prepare medication site.
2. Using syringe with 19 to 22 gauge needle, puncture resealable medication port and inject.
3. Mix solution and medication thoroughly.
To add medication during solution administration
1. Close clamp on the set.
2. Prepare medication site.
3. Using syringe with 19 to 22 gauge needle, puncture resealable medication port and inject.
4. Remove container from intravenous pole and/or turn to an upright position.
5. Mix solution and medication thoroughly.
6. Return container to in-use position and continue administration.
Laboratorios Grifols, S.A.
Murcia - SPAIN
Printed in SPAIN
Rev. 05/2017
GRIFOLS and FLEBOFLEX are trademarks of Grifols, S.A.
GRIFOLS
Laboratorios Grifols, S.A. Calle Marte nº4 - Polígono Industrial Los Llanos
30565 Las Torres de Cotillas- Murcia SPAIN

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2018 - 2019 Plastic Surgery Essentials Buying

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