Question About Sterility Related To Giving Injections

[Kooky Korky, BSN, RN]

Question:

If you draw up a dose of flu vax from a multidose vial but don't use it at the particular clinic where you are assigned that day, will it be safe to use it (still sterile, still potent) at your next clinic if you refrigerate it per company P & P?

The syringe was sterile to begin with and you know that you did not contaminate the needle, cap, barrel, etc.

The syringe, open vials, unopened vials have all been in your possession and control at all times, so you are 100% certain that they are fine.

Once in a while, a patient decides not to get the shot after it has been drawn up, so we occasionally have a drawn-up, unused dose.

Rather than waste the dose, may we safely leave it in the syringe, take care of it as described above, and use it within the next 1 - 4 days?

What about returning the unused dose to the vial it came from? This would be done as soon as it was determined that the dose would not be used at the clinic for that patient or another who comes in within a few hours. Same questions about potency and sterility.

Thanks for any help. If you know of references I can read, thanks. And if your facility has policy about this, I'd like to know that, too. If there are references about potency and sterility along with the policies, please include those.

Thanks again.

KK

[MunoRN, RN]

The bigger issue is that this would likely fall into the category of "dispensing" a medication.

The regulatory rule surrounding drawing up and labelling a medication by an RN are about as clear as mud, but generally the regulatory language limits this to a single "procedure" which is itself a pretty broad definition, but generally wouldn't include the scenario's you are referencing. This is partly due to the inability to ensure the long term sterility of the medication not prepared under the same conditions it would be by pharmacy staff (fully sterile procedure under a hood).

[Jedrnurse, BSN, RN]

I have to laugh. At first glance (of the title) I thought someone was asking if giving injections made you sterile.

[LibraSunCNM, BSN, MSN, CNM]

10 minutes ago, Jedrnurse said:

I have to laugh. At first glance (of the title) I thought someone was asking if giving injections made you sterile.

Ditto!

[Anonymous865]

per the CDC

"At end of workday, any remaining vaccine in provider predrawn syringes should be discarded."

https://www.cdc.gov/flu/professionals/vaccination/vax_clinic.htm#storage-administration

also

"Syringes other than those filled by the manufacturer should be used only for immediate administration and not for vaccine storage. "

https://www.cdc.gov/vaccines/pubs/pinkbook/vac-storage.html

[brownbook]

Great question, (and answer Anonymous 865).

Hope you're not bothered by what we thought when we read the heading.

I thought something to do with an injection being teratogenic and what proof would be required by the patient that they were sterile ?.

Are people sterile or sterilized????? Or are both acceptable?

[Lunah, MSN, RN]

When I worked at flu shot clinics (both in retail locations and also corporate programs), all unused pre-draws were discarded. I didn't pre-draw too many unless I was really getting inundated with people.

[Kooky Korky, BSN, RN]

3 hours ago, brownbook said:

Great question, (and answer Anonymous 865).

Hope you're not bothered by what we thought when we read the heading.

I thought something to do with an injection being teratogenic and what proof would be required by the patient that they were sterile ?.

Are people sterile or sterilized????? Or are both acceptable?

No offense taken.

And yes, good answer. It isn't totally specific, though. It doesn't say how long the "workday" is. Some clinics last 8 hours, some last 2 or 3.

It also doesn't say that pre-drawns from multi-dose vials MUST be discarded and not be stored in a syringe beyond an exact amount of time. Or exactly WHY pre-drawns from multi-dose vials should be wasted.

Can the vaccine cause plastic or other material from the syringe to leach into the vaccine?

I guess there might be some difference in sterility and/or potency if a vial is open or not open, but that wasn't mentioned either and I don't want to assume. And is there a definite reason (potency, sterility, other) to not keep vaccine in a syringe into which it was pre-drawn.

Anyway, I guess the best course of action is just to not draw up anything until it is certain that the pt is getting the vaccine. It does kind of slow things down and the employer gets upset if the patients complain about having to wait. Oh, well, that's just how it goes.

Thanks to all for the input.

I think people are sterilized if they have had a sterilization procedure. They are also sterile after sterilization, by whatever means - birth, surgery, medication, etc.

[Lunah, MSN, RN]

8 hours ago, Kooky Korky said:

It also doesn't say that pre-drawns from multi-dose vials MUST be discarded and not be stored in a syringe beyond an exact amount of time. Or exactly WHY pre-drawns from multi-dose vials should be wasted.

Because once you remove it from the vial, the manufacturer cannot guarantee that it is sterile. They weren't there to watch you draw it up. It's not likely that there would be anything wrong with the vaccine (heck, we used expired vaccines in Afghanistan because that is all we had), but when in doubt, follow manufacturer recommendations. I would take a look at the package inserts the next time you can.

Does the employer not have policies about this? Every flu vaccine provider I have ever worked for has very detailed policies and procedures.

[ruby_jane, BSN, RN]

What does your policy say? Failing that, I would use CDC as a reference....

[bugya90, ASN, BSN, LVN, RN]

Any unused pre-drawn vaccine should be tossed at the end of the work day per CDC policy. Also if you read the vaccine insert that come with the shipments the manufacturers have specific guidelines in regards to how long a vaccine is good for once drawn (some are very short and some are 8-10 hours).

[Kooky Korky, BSN, RN]

On 10/22/2019 at 2:58 PM, bugya90 said:

Any unused pre-drawn vaccine should be tossed at the end of the work day per CDC policy. Also if you read the vaccine insert that come with the shipments the manufacturers have specific guidelines in regards to how long a vaccine is good for once drawn (some are very short and some are 8-10 hours).

The question is WHY????