Multi Use Vials

[soozabel]

I have a question regarding using multi-use vials. Is it okay to take medication from a vial that is almost empty and transfer it to a new vial? Example: You need .05 ml of med. but there is only enough for .03, so you pull that out and open a new vial and squirt it in, then get a new needle/syringe pull the needed med from the new vial. Since a new needle/syringe is being used is this okay? The reason for this is to avoid sticking a pt twice, which is what you would have to do if this process is not allowed.

[eatmysoxRN, ASN, RN]

I don't understand why you wouldn't just either use only the new vial or only draw up the additional from the new one. Why would you squirt the other in and get another syringe? Follow policy. But I'd either get it all from one vial (most likely) or possibly just draw up the additional med into the syringe I'd already drawn the other into.

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

[mariebailey, MSN, RN]

Disregard what I said before. The needle will no longer be sterile if you insert it in another vial. You are risking contamination. You need to potentially discard the dose in the vial without the appropriate amount and start from scratch, wiping the stopper with an ETOH wipe. It would not be acceptable to inject the medication into the patient twice.

[TheCommuter, BSN, RN]

Your post has been moved to the Nursing and Patient Medications forum with the goal of eliciting the most appropriate type of feedback/responses. We wish you the best of luck!

[Jolie, BSN]

Not acceptable.

There is always the possibility that vial #1 was inadvertently contaminated (unbeknownst to you) by a previous user. If you withdraw a small amount of medicine from this vial and inject it into vial #2, you risk contaminating the entire second vial. There is also the issue that vial #1 may be nearing its discard time, and by injecting that medicine into vial #2, you shorten the usable lifespan of the medication in vial #2.

Pull the available medication out of vial #1, cap and set aside. Determine how much is needed from vial #2. Draw that up into a second syringe, then combine both volumes of medication in a single syringe and inject.

No need to stick the patient twice.

[canned_bread]

Sorry but why are you reusing a vial? We always chuck out the vial after sticking it once!!

[morte, LPN, LVN]

OP spec. stated multi dose vial....

Sorry but why are you reusing a vial? We always chuck out the vial after sticking it once!!

[KelRN215, BSN, RN]

Sorry but why are you reusing a vial? We always chuck out the vial after sticking it once!!

Some medications (like insulin) are dispensed in multi-dose vials.

OP, I don't understand why you would need to squirt the medication from the first vial into the second one. Draw it up as if you were drawing up a combo regular/NPH insulin. Draw from the first vial and then draw the remainder from the second vial into the syringe to get your full dose.

[mariebailey, MSN, RN]

FYI: I amended my orgininal answer b/c I looked it up on the CDC's website, the CDC does NOT recommend using medication from 2 multidose vials in the same syringe:

Is it acceptable to use a syringe (that has not been used on a patient) to draw up and mix contents from multiple medication vials?

The safest practice is to always enter a medication vial with a sterile needle and sterile syringe. There has been at least one outbreak attributed to healthcare personnel using a common needle and syringe to access multiple multi-dose vials for the purpose of combining their contents into a single syringe [14]. If one vial becomes contaminated, this practice can spread contamination to the others, prolonging presence of the pathogen and increasing the potential for disease transmission. Syringe reuse in this fashion may also have been a factor in additional outbreaks [9].CDC - Medication Preparation - Safe Practices for Medical Injections FAQs - Injections Safety

I was taught out of nursing school by by nurse manager that it was ok for multidose vials of vaccines as long as it was the same lot #, but apparently this is not true!!!

[PediLove2147, BSN, RN]

FYI: I amended my orgininal answer b/c I looked it up on the CDC's website, the CDC does NOT recommend using medication from 2 multidose vials in the same syringe:

Is it acceptable to use a syringe (that has not been used on a patient) to draw up and mix contents from multiple medication vials?

The safest practice is to always enter a medication vial with a sterile needle and sterile syringe. There has been at least one outbreak attributed to healthcare personnel using a common needle and syringe to access multiple multi-dose vials for the purpose of combining their contents into a single syringe [14]. If one vial becomes contaminated, this practice can spread contamination to the others, prolonging presence of the pathogen and increasing the potential for disease transmission. Syringe reuse in this fashion may also have been a factor in additional outbreaks [9].CDC - Medication Preparation - Safe Practices for Medical Injections FAQs - Injections Safety

I was taught out of nursing school by by nurse manager that it was ok for multidose vials of vaccines as long as it was the same lot #, but apparently this is not true!!!

But then, I'll use the same senario as KelRN, you would need to stick the patient twice in the instance of NPH/Regular Insulin. It is standard to mix these two and in order to do that you cannot use a sterile needle after drawing up the Regular..

[mariebailey, MSN, RN]

But then, I'll use the same senario as KelRN, you would need to stick the patient twice in the instance of NPH/Regular Insulin. It is standard to mix these two and in order to do that you cannot use a sterile needle after drawing up the Regular..

"While it is not recommended to use the same needle and syringe to enter more than one medication vial because of the risks described above, there are circumstances where more than one vial may need to be entered with the same syringe and needle (e.g., when reconstituting medications or vaccines). In these circumstances, aseptic technique must be followed and reconstitution should be performed in a designated clean medication area that is not adjacent to areas where potentially contaminated items are placed." I would think this would apply to the situation you described above as well.

CDC - Medication Preparation - Safe Practices for Medical Injections FAQs - Injections Safety

[iluvivt, BSN, RN]

Also see APIC's guidelines ..http://www.apic.org/Resource_/TinyMceFileManager/Position_Statements/AJIC_Safe_Injection0310.pdf..