2 insulins = 2 injections

[Graduatenurse14]

I'm a new RN still in orientation. We give insulin using vials that are used for several patients at one time.

If a patient has to be given a mixed dose, two syringes are used rather than mix them in one syringe following the cloudy/clear rules. The patient gets two injections.

That doesn't seem good for the patient as it's more opportunity for pain and the less amount of times we have to inject into the skin to prevent opportunity for infection, the better, right??

[CrunchRN, ADN, RN]

They must be worried about cross contamination of the different types of insulin. Seems ridiculous to use shared vials in this day and age of supposedly heightened patient safety.

[BuckyBadgerRN, ASN, RN]

Why in the world are multiple patients sharing the same vial of insulin? That seems to be the bigger question here...

[KelRN215, BSN, RN]

Insulin comes in multi-dose vials but the pharmacy should be dispensing separate vials for each patient...

[caliotter3]

Each patient always had their own, labeled vial at all the places I have worked.

[applewhitern, BSN, RN]

I have worked in hospitals for over 25 years now, and I have never had a separate vial of insulin for any patient; they all used multi-dose vials. Nothing could get "cross contaminated" because you would draw up the insulin with a fresh syringe, after cleaning the top of the vial with alcohol. The vial itself never enters the patient's room. As far as getting contaminated by different proteins, if you follow the rules about fast vs. long-acting, that shouldn't happen either. That said, there are insulins that shouldn't be mixed with any other one, such as Lantus.

[nolanurse88]

I've never seen each patient having their own vial.. Whatever type of insulin they need we just pull it from the Pyxis that everyone uses. To answer the post, we also don't mix insulins and will give 2 shots.

[britpanda]

We also have multiple dose vials that we use for multiple patients and therefore have to give 2 injections versus mixing the short acting and longer acting insulins. I have also seen it this way in multiple facilities across our city during my nursing school rotations so it obviously is still a common practice within some healthcare systems. I can certainly see both sides to the argument, but obviously facility policy overrides my desire to minimize multiple injections for a patient

[Graduatenurse14]

I'm sure it's a $$$ reason. All of the syringes are brand new and the vials are swabbed so there is no patient contact with the vials. Also they are pulled up in the med room so the vials never leave there so there's no cross contamination.

It's the two injections that I don't like. I have to look at the official policy next shift. I will do one if we're allowed.

[Tenebrae, BSN, RN]

When I was working on surgical, we would use the one vial for multiple people however the vial never left the drug room. And as others have said, the top would be swabbed with a new alcohol swab inbetween use.

Bear in mind when a needle goes into the top of the vial its straight out of sterile packaging. I fail to see the risk for cross infection if done correctly and in order

[CopperEmerald]

I have always given two shots in place I've worked, never mixing them. I actually prefer that way, despite having to give two shots, because (and I hate to have to say this) I have worked with nurses that wouldn't take the time to figure out the order you draw it up if they didn't know. Eliminates that margin of error.