Q for those who use Lidocaine injection vials

[klone, MSN, RN]

I'm talking about 20ml vials used for injection...

Do you treat them as multi-use or single use?

These vials DO contain preservatives.

Every place I've worked, we've had them as multi-use, and we would just write the date it was first opened.

Where I work now, we use a lot of Lidocaine for local anesthesia before contraceptive implant placement, as well as to reconstitute ceftriaxone. The most that's ever used at once is 4 ml, and usually it's 1 or 2 ml. And these are 20 ml vials (I've been trying to get my manager to approve ordering 10ml vials, but apparently the 20 ml is actually cheaper, go figure). Anyway, our policy is single use - we throw the bottle away after the patient. It's SUCH a waste!

[TakeTwoAspirin, MSN, RN, APRN]

It should say on the label whether or not it is for single use. Given that most facilities are penny pinching, I'm quite impressed that you facility is actually putting safety first regardless. Certainly, there is a lot more risk for cross contamination with multiple use.

[klone, MSN, RN]

It should say on the label whether or not it is for single use.

Yes, they all say "multiple dose" on them. Nevertheless, we've been told that they should be discarded after every use. I think that's incredibly wasteful. We draw up and mix in a clean med area. The vials themselves are not in patient care areas. And we all use exemplary technique. And, well, they contain preservative and ARE designed for multi-use.

[Asystole RN]

Single use.

The current trend is to go to as many single use items as possible for patient safety.

All it takes is ONE nurse making a mistake ONCE to cause an incredible amount of destruction. There are stories after stories after stories of the same exact scenario happening again and again.

Wasteful? Talk to your administration. Lido is not thatexpensive and they might run through the cost/benefit analysis with you. Sometimes it is better to spend a few thousand a year more rather than risk a situation that can result in a catastrophic, financially ruinous, situation.

Critically think about it, if you are using enough lido as single use vials to justify stocking single use vials of lido then maybe it would be best for the admins to obtain single use lido.

[Ayvah, RN]

We use our lidocaine vials on multiple patients.

[klone, MSN, RN]

According to pharmacy, the small single use vials are actually more expensive.

[SierraBravo]

Per USP 797, the beyond use date for multi use vials is 28 days unless otherwise stated on the manufacturers label or package insert. The vial should be labeled with the date it was first opened. Additionally, the vials should be stored away from patient care areas to avoid any potential contamination. The fact that multi use vials are good for 28 days does not preclude the necessity for sterile technique each time the vial is accessed. Also, multi use vials should be refrigerated unless otherwise stated on the manufacturers label.

Discarding each multi use vial after each use is certainly wasteful. For example, to reconstitute a 1g vial of ceftriaxone for intramuscular injection (250mg/mL) you would use 3.6mL of 1% lidocaine. This would mean that over 16mL of lidocaine is remaining, thus resulting in an 82% waste of lidocaine if each multi use vial is only used once.

Does your facility use any variant of Six Sigma? This would be a wonderful project for someone.

[klone, MSN, RN]

Yes, our hospital is "Lean". I agree, it would be a good project (I have 2 projects on my "to do" list before that, though :))

I looked, and our facility policy is that multi-use vials are okay for multi-use when used according to manufacturer recommendations, WITH THE EXCEPTION of anesthetics. Not sure why anesthetics are exceptions, but that's why we have to toss it. I spoke to the pharmacy ordering person, and she said the 20ml vials are actually cheaper to buy than the smaller quantities. I think it's actually because of the packaging - the 20ml vials are plastic, and the times I've seen smaller vials, they've been glass.