Acidosis, Respiratory

Now compatible with all major RFID kit and tray systems LAKE ZURICH, Ill.--(BUSINESS WIRE)-- Fresenius Kabi announced today it has introduced +RFID smart labels for Diprivan® (Propofol) Injectable Emulsion, USP, 200 mg per 20 mL in single-dose vials, sold in the United States. The +RFID labels are now fully compatible with all major RFID kit and tray systems in the U.S. This press release features multimedia. View the full release here: Fresenius Kabi Diprivan® (Propofol) Injectable Emulsion, USP, 200 mg per 20 mL in single-dose vials, now compatible with all major RFID kit and tray systems. (Photo: Business Wire) The launch expands Fresenius Kabi’s industry-leading +RFID portfolio of fully interoperable labeled medications. The use of radio-frequency identification (RFID) label technology eliminates the need to tag medicines manually which saves time and supports a safe, more efficient medication inventory process. Fresenius Kabi is the first pharmaceutical manufacturer to adopt GS1's EPC Tag Data Standard (TDS) to enhance interoperability. GS1 Standards for identifying, capturing and sharing supply chain data help ensure product and inventory information is accessible, accurate and easy to understand. Diprivan, the most prescribed propofol anesthetic in the U.S.1, was the first Fresenius Kabi product introduced with RFID labels in 2020 for use with some RFID kit and tray systems. The drug is now certified for use with all RFID systems and is available immediately to order through wholesalers and direct from Fresenius Kabi. To meet the highest standards of performance and quality, in addition to the company’s own testing, Diprivan +RFID has been tested by the Axia Institute of Michigan State University and certified by the ARC RFID lab of Auburn University. Fresenius Kabi is expanding its portfolio of fully compatible +RFID products based on demand from hospitals. In a recent study by the ASHP Foundation, nearly nine in 10 hospitals that participated reported they are already using RFID technology or are evaluating it. “We are dedicated to supporting our customers in the adoption of RFID technology that enhances patient care, improves efficiency and streamlines workflows for pharmacists,” said John Ducker, president and CEO of Fresenius Kabi USA. The company has also released newly labeled Vasopressin Injection, USP 20 units per 1 mL in single-dose vials with +RFID smart labels, adding to the company’s growing portfolio of products compatible with all major RFID kit and tray systems. About Diprivan® (Propofol), Injectable Emulsion, USP Indications and Usage – DIPRIVAN® (Propofol), Injectable Emulsion, USP is an intravenous general anesthetic and sedation drug for use in adults for initiation and maintenance of Monitored Anesthesia Care (MAC) sedation, combined sedation and regional anesthesia, and Intensive Care Unit (ICU) sedation of intubated, mechanically ventilated patients. DIPRIVAN is also indicated for induction of general anesthesia for patients greater than or equal to 3 years of age and for maintenance of general anesthesia for patients greater than or equal to 2 months of age. Important Safety Information DIPRIVAN is contraindicated in patients with a known hypersensitivity to propofol or any of DIPRIVAN components, and also in patients with allergies to eggs, egg products, soybeans or soy products. DIPRIVAN is not indicated for use in pediatric patients for ICU sedation or for MAC sedation for surgical, nonsurgical or diagnostic procedures as safety and effectiveness have not been established. DIPRIVAN is not recommended for induction of anesthesia in patients below the age of 3 years or for maintenance of anesthesia in patients below the age of 2 months because its safety and effectiveness have not been established in those populations. Use of DIPRIVAN has been associated with both fatal and life-threatening anaphylactic and anaphylactoid reactions. Clinical features of anaphylaxis, including angioedema, bronchospasm, erythema, and hypotension occur rarely following DIPRIVAN administration. Strict aseptic technique must always be maintained during handling. DIPRIVAN is a single access parenteral product (single patient infusion vial) which contains 0.005% disodium edetate (EDTA) to inhibit the rate of growth of microorganisms, for up to 12 hours, in the event of accidental extrinsic contamination. However, DIPRIVAN can still support the growth of microorganisms, as it is not an antimicrobially preserved product under USP standards. Failure to use aseptic technique when handling DIPRIVAN was associated with microbial contamination of the product and with fever, infection, sepsis, other life-threatening illness, and death. Do not use if contamination is suspected. Discard unused drug product as directed within the required time limits. There have been reports, in the literature and other public sources, of the transmission of bloodborne pathogens (such as Hepatitis B, Hepatitis C, and HIV) from unsafe injection practices, and use of propofol vials intended for single use on multiple persons. A DIPRIVAN vial is never to be accessed more than once or used on more than one person. DIPRIVAN has no vagolytic activity. Reports of bradycardia, asystole, and rarely, cardiac arrest have been associated with DIPRIVAN. Pediatric patients are susceptible to this effect, particularly when fentanyl is given concomitantly. Diprivan should not be coadministered through the same IV catheter with blood or plasma because compatibility has not been established. For general anesthesia or monitored anesthesia care (MAC) sedation, DIPRIVAN should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure. Sedated patients should be continuously monitored, and facilities for maintenance of a patent airway, providing artificial ventilation, administering supplemental oxygen, and instituting cardiovascular resuscitation must be immediately available. Patients should be continuously monitored for early signs of hypotension, apnea, airway obstruction, and/or oxygen desaturation. These cardiorespiratory effects are more likely to occur following rapid bolus administration, especially in the elderly, debilitated, or ASA-PS III or IV patients. Administer DIPRIVAN with caution in patients with disorders of lipid metabolism such as primary hyperlipoproteinemia, diabetic hyperlipemia, and pancreatitis. Very rarely the use of DIPRIVAN may be associated with the development of a period of postoperative unconsciousness which may be accompanied by an increase in muscle tone. When DIPRIVAN is administered to an epileptic patient, there is a risk of seizure during the recovery phase. Attention should be paid to minimize pain on administration of Diprivan. Venous sequelae, i.e., phlebitis or thrombosis, have been reported rarely (less than 1%). Perioperative myoclonia, rarely including convulsions and opisthotonos, has occurred in association with DIPRIVAN administration. Rarely, cases of unexplained postoperative pancreatitis (requiring hospital admission) have been reported after anesthesia in which DIPRIVAN was one of the induction agents used. For sedation of intubated, mechanically ventilated patients in the Intensive Care Unit (ICU), DIPRIVAN should be administered only by persons skilled in the management of critically ill patients and trained in cardiovascular resuscitation and airway management. Patients should be continuously monitored for early signs of significant hypotension and/or cardiovascular depression, which may be profound. Abrupt discontinuation of DIPRIVAN prior to weaning or for daily evaluation of sedation levels should be avoided. This may result in rapid awakening with associated anxiety, agitation, and resistance to mechanical ventilation. In pediatric patients, abrupt discontinuation of DIPRIVAN following prolonged infusion may result in flushing of the hands and feet, agitation, tremulousness and hyperirritability. Increased incidences of bradycardia, agitation, and jitteriness have also been observed. For both adult and pediatric ICU sedation, DIPRIVAN infusion has been associated with Propofol Infusion Syndrome, that have resulted in death. The syndrome is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, renal failure, ECG changes and/or cardiac failure. Since DIPRIVAN is formulated in an oil-in-water emulsion, elevations in serum triglycerides may occur when DIPRIVAN is administered for extended periods of time. Patients at risk of hyperlipidemia should be monitored for increases in serum triglycerides or serum turbidity. EDTA is a strong chelator of trace metals – including zinc. DIPRIVAN should not be infused for longer than 5 days without providing a drug holiday to safely replace estimated or measured urine zinc losses. At high doses (2 grams to 3 grams per day), EDTA has been reported, on rare occasions, to be toxic to the renal tubules. Monitor patients at risk for renal impairment. There have been rare reports of pulmonary edema in temporal relationship to the administration of DIPRIVAN, although a causal relationship is unknown. Neurosurgical Anesthesia: When DIPRIVAN is used in patients with increased intracranial pressure or impaired cerebral circulation, significant decreases in mean arterial pressure should be avoided because of the resultant decrease in cerebral perfusion pressure. Cardiac Anesthesia: Slower rates of administration should be utilized in premedicated patients, geriatric patients, patients with recent fluid shifts, and patients who are hemodynamically unstable. Pediatric Neurotoxicity: Published animal studies demonstrate that the administration of anesthetic and sedation drugs that block NMDA receptors and/or potentiate GABA activity increase neuronal apoptosis in the developing brain and result in long-term cognitive deficits when used for longer than 3 hours. The clinical significance of these findings is unclear. Adverse reactions reported with an incidence greater than 1% were: bradycardia, arrhythmia, tachycardia, hypotension, decreased cardiac output, hypertension, movement, apnea, respiratory acidosis during weaning, rash, pruritus, burning/stinging or pain at injection site, and hyperlipemia. To report SUSPECTED ADVERSE REACTIONS, contact Fresenius Kabi USA, LLC at 1-800-551-7176, option 5, or FDA at 1-800-FDA-1088 or . DIPRIVAN is not recommended for obstetrics, including Cesarean section deliveries. DIPRIVAN crosses the placenta, and as with other general anesthetic agents, the administration of DIPRIVAN may be associated with neonatal depression. DIPRIVAN is not recommended for use in nursing mothers because Propofol has been reported to be excreted in human milk, and the effects of oral absorption of small amounts of propofol are not known. This Important Safety Information does not include all the information needed to use DIPRIVAN® (Propofol), Injectable Emulsion, USP safely and effectively. Please see full prescribing information for DIPRIVAN® (Propofol), Injectable Emulsion, USP at . References 1. Data on file. About Fresenius Kabi Fresenius Kabi ( ) is a global health care company that specializes in injectable medicines, biosimilars, and technologies for infusion, transfusion, and clinical nutrition. The company’s products and services are used to help care for patients with critical and chronic conditions. The company’s U.S. headquarters is in Lake Zurich, Illinois. The company’s global headquarters is in Bad Homburg, Germany. To learn about U.S. career opportunities at Fresenius Kabi, visit us at and follow us on LinkedIn.

DUBLIN, Jan. 10, 2023 /PRNewswire/ -- The "Choline Chloride Market By Form, By Application: Global Opportunity Analysis and Industry Forecast, 2021-2031" report has been added to ResearchAndMarkets.com's offering. The global choline chloride market was valued at $494.4 million in 2021, and is projected to reach $916.9 million by 2031, growing at a CAGR of 6.4% from 2022 to 2031. The growth of the global choline chloride market is driven by increase in use of choline chloride in personal care and pharmaceutical end-use industries. Choline chloride acts as a lipotropic agent which increase the transport and metabolism of lipids including synthesis of lipoprotein and also act as a nootropic agent, thus making it widely used during formulation of pharmaceutical products. Pharmaceutical formulations require analyte for determination of the efficiency of the formulations. Several pharmaceutical reference standard are used for determination of analyte efficiency and these are known as secondary standards or certified reference materials. Choline chloride is mainly used as certified reference material is the key market trend. In addition, pharma grade choline chloride is used widely as a raw material for production of pharma or biopharmaceutical cell culture media products drives the demand for the global market. Solvents are important intermediate compounds that are vital during purification of pharmaceutical excipients and products. Moreover, growing concern over green chemistry has created immense opportunities for growth of bio-based solvents in pharmaceutical industry. Several studies suggest the efficiency and sustainability of choline chloride being used as solvent for pharmaceutical purification. All these factors have collectively surged the demand for global market. However, there are several side effects associated with excessive use of human nutritional products containing choline chloride. As per the prescribed value, consumption of choline chloride containing human nutritional products is 3.5 grams per day. Excessive use over prescribed value leads to diarrhea and vomiting sensation. In addition, over usage leads to side effects during pregnancy and lactation period. Other side effects such as Congestive heart failure, Dehydration, Excessive sweating, and Respiratory acidosis, have been observed with consumption of large amount of human nutritional products containing choline chloride. Choline chloride is used in oil and gas industry during exploration, production, and refining process. Choline chloride is used as an auxiliary chemical compound owing to its ability to stabilize machine shafts during exploration, deliver efficient bit cuttings, increase the underground safety and improves machine's rotational speed. Moreover, it can also be used as shale inhibitor in drilling fluids. Mainly potassium chloride (KCL) was used as clay stabilizer during oil and natural gas production and purification. However, owing to choline chloride structural characteristics, effectiveness and environment friendly characteristics makes it viable stabilizers over other clay stabilizers drives the demand of the global market. In addition, choline chloride tend to minimize the release of chloride content by 70%-75% making it widely adopted clay stabilizer over KCL. Clay stabilizers play important role during petroleum drilling and purification. However, KCL tend to escalate the inhibitory effect thereby hampering petroleum purity. The mass fraction of choline chloride is 1%-2% and contains inorganic salt is over 3% making it suitable to prohibit inhibitory effect is another considerable factor driving the demand of the global market. The choline chloride market is segmented on the basis of form, application, and region. By form, the market is segregated into powder and liquid. By application, it is segregated into animal feed, oil and gas, human nutrition, personal care, pharmaceuticals, and others. Region-wise, it is analyzed across North America, Europe, Asia-Pacific, and LAMEA. The global chromatography resins market profiles leading players that include Cytiva Lifesciences, Bio-Rad Laboratories Inc., Sartorius AG, Generon, Tosoh Bioscience, Bio-Works, Repligen Corporation, LAF-Biotechnology, JNC Corporation, Anatrace Products LLC. The global chromatography resins market report provides in-depth competitive analysis as well as profiles of these major players Key Benefits This report provides a quantitative analysis of the market segments, current trends, estimations, and dynamics of the choline chloride market analysis from 2021 to 2031 to identify the prevailing choline chloride market opportunities. The market research is offered along with information related to key drivers, restraints, and opportunities. Porter's five forces analysis highlights the potency of buyers and suppliers to enable stakeholders make profit-oriented business decisions and strengthen their supplier-buyer network. In-depth analysis of the choline chloride market segmentation assists to determine the prevailing market opportunities. Major countries in each region are mapped according to their revenue contribution to the global market. Market player positioning facilitates benchmarking and provides a clear understanding of the present position of the market players. The report includes the analysis of the regional as well as global choline chloride market trends, key players, market segments, application areas, and market growth strategies. Key Topics Covered: CHAPTER 1: INTRODUCTION CHAPTER 2: EXECUTIVE SUMMARY CHAPTER 3: MARKET OVERVIEW 3.1.Market definition and scope 3.2.Key findings 3.2.1.Top investment pockets 3.3.Porter's five forces analysis 3.4.Top player positioning 3.5.Market dynamics 3.5.1.Drivers 3.5.2.Restraints 3.5.3.Opportunities 3.6.COVID-19 Impact Analysis on the market 3.7.Pricing Analysis 3.8.Regulatory Guidelines 3.9.Value Chain Analysis 3.10.Patent Landscape 3.11.Key Regulation Analysis CHAPTER 4: CHOLINE CHLORIDE MARKET, BY FORM 4.1 Overview 4.1.1 Market size and forecast 4.2 Powder 4.2.1 Key market trends, growth factors and opportunities 4.2.2 Market size and forecast, by region 4.2.3 Market analysis by country 4.3 Liquid 4.3.1 Key market trends, growth factors and opportunities 4.3.2 Market size and forecast, by region 4.3.3 Market analysis by country CHAPTER 5: CHOLINE CHLORIDE MARKET, BY APPLICATION 5.1 Overview 5.1.1 Market size and forecast 5.2 Animal Feed 5.2.1 Key market trends, growth factors and opportunities 5.2.2 Market size and forecast, by region 5.2.3 Market analysis by country 5.3 Oil and Gas 5.3.1 Key market trends, growth factors and opportunities 5.3.2 Market size and forecast, by region 5.3.3 Market analysis by country 5.4 Human Nutrition 5.4.1 Key market trends, growth factors and opportunities 5.4.2 Market size and forecast, by region 5.4.3 Market analysis by country 5.5 Personal Care 5.5.1 Key market trends, growth factors and opportunities 5.5.2 Market size and forecast, by region 5.5.3 Market analysis by country 5.6 Pharmaceuticals 5.6.1 Key market trends, growth factors and opportunities 5.6.2 Market size and forecast, by region 5.6.3 Market analysis by country 5.7 Others 5.7.1 Key market trends, growth factors and opportunities 5.7.2 Market size and forecast, by region 5.7.3 Market analysis by country CHAPTER 6: CHOLINE CHLORIDE MARKET, BY REGION CHAPTER 7: COMPANY LANDSCAPE 7.1. Introduction 7.2. Top winning strategies 7.3. Product Mapping of Top 10 Player 7.4. Competitive Dashboard 7.5. Competitive Heatmap 7.6. Key developments CHAPTER 8: COMPANY PROFILES 8.1 ALGRY Quimica S.L 8.1.1 Company overview 8.1.2 Company snapshot 8.1.3 Operating business segments 8.1.4 Product portfolio 8.1.5 Business performance 8.1.6 Key strategic moves and developments 8.2 Balaji Amines Ltd. 8.2.1 Company overview 8.2.2 Company snapshot 8.2.3 Operating business segments 8.2.4 Product portfolio 8.2.5 Business performance 8.2.6 Key strategic moves and developments 8.3 Balchem Inc. 8.3.1 Company overview 8.3.2 Company snapshot 8.3.3 Operating business segments 8.3.4 Product portfolio 8.3.5 Business performance 8.3.6 Key strategic moves and developments 8.4 BASF SE 8.4.1 Company overview 8.4.2 Company snapshot 8.4.3 Operating business segments 8.4.4 Product portfolio 8.4.5 Business performance 8.4.6 Key strategic moves and developments 8.5 Eastman Chemical Company 8.5.1 Company overview 8.5.2 Company snapshot 8.5.3 Operating business segments 8.5.4 Product portfolio 8.5.5 Business performance 8.5.6 Key strategic moves and developments 8.6 Imperial Group Limited 8.6.1 Company overview 8.6.2 Company snapshot 8.6.3 Operating business segments 8.6.4 Product portfolio 8.6.5 Business performance 8.6.6 Key strategic moves and developments 8.7 Jubilant Ingrevia Limited 8.7.1 Company overview 8.7.2 Company snapshot 8.7.3 Operating business segments 8.7.4 Product portfolio 8.7.5 Business performance 8.7.6 Key strategic moves and developments 8.8 Kemin Industries Inc. 8.8.1 Company overview 8.8.2 Company snapshot 8.8.3 Operating business segments 8.8.4 Product portfolio 8.8.5 Business performance 8.8.6 Key strategic moves and developments 8.9 Liaoning Biochem Co. Ltd. 8.9.1 Company overview 8.9.2 Company snapshot 8.9.3 Operating business segments 8.9.4 Product portfolio 8.9.5 Business performance 8.9.6 Key strategic moves and developments 8.10 Merck KGaA 8.10.1 Company overview 8.10.2 Company snapshot 8.10.3 Operating business segments 8.10.4 Product portfolio 8.10.5 Business performance 8.10.6 Key strategic moves and developments 8.11 Nuproxa Switzerland Ltd. 8.11.1 Company overview 8.11.2 Company snapshot 8.11.3 Operating business segments 8.11.4 Product portfolio 8.11.5 Business performance 8.11.6 Key strategic moves and developments 8.12 Pestell Nutrition Inc. 8.12.1 Company overview 8.12.2 Company snapshot 8.12.3 Operating business segments 8.12.4 Product portfolio 8.12.5 Business performance 8.12.6 Key strategic moves and developments 8.13 SDA Product 8.13.1 Company overview 8.13.2 Company snapshot 8.13.3 Operating business segments 8.13.4 Product portfolio 8.13.5 Business performance 8.13.6 Key strategic moves and developments 8.14 Spectrum Chemical 8.14.1 Company overview 8.14.2 Company snapshot 8.14.3 Operating business segments 8.14.4 Product portfolio 8.14.5 Business performance 8.14.6 Key strategic moves and developments 8.15 TOKYO CHEMICAL INDUSTRY CO., LTD. 8.15.1 Company overview 8.15.2 Company snapshot 8.15.3 Operating business segments 8.15.4 Product portfolio 8.15.5 Business performance 8.15.6 Key strategic moves and developments For more information about this report visit Media Contact: Research and Markets Laura Wood, Senior Manager [email protected] For E.S.T Office Hours Call +1-917-300-0470 For U.S./CAN Toll Free Call +1-800-526-8630 For GMT Office Hours Call +353-1-416-8900 U.S. Fax: 646-607-1907 Fax (outside U.S.): +353-1-481-1716 Logo: SOURCE Research and Markets

The Association of periOperative Registered Nurses (AORN)’s 2021 Guidelines for Perioperative Practice is out, with six revised guidelines. Published each January, the document includes 34 guidelines that offer evidence-based recommendations promoting safe perioperative patient care and workplace safety. The latest edition includes revisions to guidelines for laser safety, electrosurgical safety, pneumatic tourniquet safety, instrument care and cleaning, care of the patient receiving local-only anesthesia, and specimen management. A few of the updates could impact medical device companies. MD+DI asked the AORN team a few questions. Below we share feedback from Erin Kyle, DNP, RN, CNOR, NEA-BC, editor-in-chief, Guidelines for Perioperative Practice; Lisa Spruce, DNP, CNOR, CNS-CP, FAAN, director of evidence-based perioperative practice; Mary Alice Anderson, MSN, RN, CNOR, perioperative practice specialist; and Julie Cahn, DNP, RN, CNOR, RN-BC, ACNS-BC, CNS-CP; senior perioperative practice specialist. What steps can manufacturers of surgical instruments and devices take to ensure proper instrument processing? Kyle: When designing surgical instruments, manufacturers should prioritize functionality, durability, and cleanability equally. Testing cleaning of medical devices under worse-case conditions when pursuing FDA clearance is essential, and using the information learned in this testing should inform care and cleaning instructions for use. What support can they offer to help personnel use objective measurement tools to monitor the quality of water used in instrument processing and to also use objective measurements to evaluate cleaning effectiveness? Kyle: The IFU should give detailed information about all aspects of instrument cleaning from point-of-use treatment, through manual and mechanical cleaning processes, inspection, assembly, packaging, and sterilization. The quality of water used in instrument cleaning is an important element that influences the effectiveness of cleaning. Manufacturers of surgical instruments and other reusable medical devices should include the importance of water quality when providing education and in-service for sterile processing personnel. Are there any design recommendations? Kyle: When designing surgical instruments and other reusable medical devices, manufacturers should include cleanability, including consideration for human factors for the device. An instrument that is not cleanable cannot be effectively sterilized, and the consequences of cleaning and sterilization failures can lead to catastrophic harm to patients from surgical-site infections. What steps can manufacturers of electrosurgical and laser devices take to promote safe use? Spruce: AORN recommends that perioperative personnel follow the manufacturer’s instructions for use for all electrosurgical or laser devices being used. It is important for manufacturers to provide a comprehensive instruction manual that includes details about how to set up the device and safety information that will protect patients as well as perioperative team members. Additionally, manufacturers should have detailed troubleshooting information, frequently asked questions, and other pertinent information and support readily available. Manufacturer representatives should be available for phone or in-person consultations as well as to educate perioperative teams when new equipment is being implemented. Additionally, FDA has listed requirements that manufacturers should include in device instructions for use. Are there any design recommendations? Spruce: No, but because qualified personnel (e.g., a biomedical engineering services representative) must perform periodic monitoring, inspection, testing, and maintenance on the electrosurgical generator, the manufacturer’s instructions for use are of the utmost importance. Additionally, FDA has developed guidance documents to assist industry in preparing premarket notification of new devices that includes a description of the device’s design. Manufacturers would provide a brief description of the device’s operating principle(s) and mechanism of action for achieving the intended effects. If perioperative team members suspect an ESU may have caused a serious patient injury or death, personnel should follow their facility’s policies and procedures to report the event to FDA and, if known, the device manufacturer. Device malfunctions also may be reported to FDA. Are there any suggestions on design or function of pneumatic tourniquets? Anderson: It would be great to see all non-latex tourniquet cuffs that are more flexible, with built in padding and a clear cover that follows the same direction of the cords to the machine, with potentially longer sterile cords that go to the machine. I would also think that retractable cords would be beneficial, maybe an antibacterial coating around the cord plug. As for the machine, I think that some way to distinguish visually and audibly for right/left or upper/lower extremities alerts would be beneficial. Also, CO 2 or O 2 levels measured within the cuff or on a pulse oximeter with different alerts. Here is a summary of recommendations: Flexible to different limb sizes Built-in padding (even sterile) Built-in clear cover—same direction of cords—prevents multiple problems Longer sterile tubing—could go all the way to the machine? No latex Distinguish side Voice for alarm—distinguish side R/L or U/L Retractable cords Antibacterial coating for cords Sensory for O 2 —sensor for CO 2 for peds as well Are there any steps manufacturers can take to help monitor pediatric patients for respiratory acidosis during procedures where pneumatic tourniquets are used? Anderson: Unfortunately, respiratory acidosis signs and symptoms may not be seen with anesthesia; common symptoms include headache, anxiety, confusion, flushed skin. Blood gas tension measured by an arterial line is also expensive and time-ineffective for short cases; however, any case over 75 minutes may benefit. There is one article that discussed a cuff that was able to measure CO 2 pH levels in the blood, and that technology, along with O 2 to measure limb occlusion pressure, may be beneficial to OR staff and protect patients from the risk of respiratory acidosis. Here is a summary of symptoms to monitor: Raised CO 2 pH levels in blood - PaCO2 >45 mmHg, pH <7.35 pH levels in blood - PaCO2 >45 mmHg, pH <7.35 Awake symptoms - headache, memory loss, anxiety or personality changes, confusion, drowsiness, stupor, muscle jerking, reduced heart muscle function for chronic - arrhythmias, drop blood pressure More - muscle twitching, warm, flushed skin, nausea, vomiting, Blood gas tension measured by ABGs/arterial line in literature if tourniquet expected >75 min What can manufacturers do to support safe specimen management, such as handling of highly infectious specimens as well as radioactive seed localization specimens? Cahn: Manufacturers of products involved in specimen containment and labeling should be aware of the common types of specimen errors. The 2021 AORN Guideline for Specimen Management contains a table (Table 7) that outlines the types of specimen errors that occur in the preanalytical phase (i.e., before the specimen reaches the pathology laboratory). Examples of common types of errors include problems during collection (e.g., wrong container used, wrong solution used), container labeling (e.g., missing labels, wrong information on the label), storage (e.g., not refrigerated), transport (e.g., leaking or spilled solution), and quality (e.g., quantity not sufficient). Specimen errors are more likely to occur in the preanalytical phase of specimen management when compared to the analytical and postanalytical phases. When possible, manufacturers should consider if design modifications in their products may: Reduce any type of specimen errors (e.g., identification, labeling), Decrease personnel exposures to hazardous chemicals (e.g., formaldehyde), Reduce personnel exposures to radioactive material (if applicable), Reduce personnel exposures to blood or other potentially infectious material, Decrease the potential for injuries to personnel from sharps contained within specimens (e.g., clips, markers, or wires in breast cancer specimens), and Facilitate transport, storage, and processing of the specimen (e.g., pathology laboratory, radiology department, nuclear medicine department). Additionally, manufacturers with products that support specimen management should consider whether technological advances could be imbedded into the design to help reduce specimen errors (e.g., point-of-care bar code systems, radio-frequency identification [RFID]). Recommended processes for containment, labeling, and transfer of highly infectious specimens are not dramatically different from normal specimen management procedures. Manufacturers of products used in containment of highly infectious specimens may want to consider that personnel may be disinfecting the exterior portion of the specimen container. Therefore, making the device easy to disinfect and compatible with EPA-registered disinfectants commonly available in healthcare facilities may be beneficial. The differences in management of highly infectious specimens is rooted in enhanced communication regarding the specimen. Medical use of radioactive materials (e.g., seeds) is regulated by the Nuclear Regulatory Commission (NRC). Due to the NRC or applicable agreement state regulations, it is important to account for all radioactive seeds. If there is ever a question about the location of a seed, a radiographic film of the specimen may be taken to verify whether the seed is in the specimen. This may occur when the specimen is already in a container. Therefore, use of non-radiopaque specimen containers may be helpful in containment of specimens containing radioactive seeds. I see that the Guidelines for Perioperative Practice are revised each year. Is there a process for medical device manufacturers to be involved with to support safe perioperative patient care and achieve workplace safety? Spruce: Yes, the AORN Guidelines for Perioperative Practice provide the foundation for professional, evidence-based, perioperative nursing practice. Every perioperative team member as well as industry partners have a responsibility to actively participate in the development and review of professional guidelines. This participation is achieved through the public commenting process. Manufacturers can read and review every guideline and provide comments. Input received from perioperative team members and other stakeholders strengthen the guidelines because they provide AORN with input from team members practicing in a wide variety of facilities, specialties, roles, and locations throughout the United States and other countries.