Single dose vial meds

[curtiv]

if a patient is ordered 25mcg of fentanyl times 3 doses till pain free q 10 minutes... can you draw up the whole vial of fentanyl 100mcg and then hold the rest and give the followup administration from that same syringe to the SAME patient as long as the med syringe is sterile capped between each dose?? i cant find squat that says you cant or that you can... it just states cant be done on multiple patients and a single dose vial should not be reentered multiple times for the same patient.

I dont work in an OR but dont they give sedation from a syringe and titrate the dose?? do they never disconnect??

[MunoRN, RN]

This is going to come down to your facility policy. There are regulations that require vials and syringes be used for only one patient, but they do not prohibit giving multiple doses from a single dose vial so long as the vial is only accessed once. I'd be careful about determining good practice from what happens in the OR. Despite recent hepatitis outbreaks due to anesthesiologists and CRNA's giving multiple patients drugs from the same vial, even the same syringe, their are polls that show it's still done by 25-30% of anesthesiologists and CRNA's at least on occasion.

The FDA and DEA do require that drawn up medications be properly labelled and stored securely. The policy where I work is that we can draw up the full vial, label it, store it securely, and we can then give divided doses out of that syringe (to the same patient). If your policy doesn't allow it, or you don't have proper secure storage for it, then you can't.

[AnonRNC]

Are you suggesting that you draw up 100mcg of fentanyl in ONE syringe and then "just" push 25mcg at a time? If so, that sounds like a dangerous practice....too much risk that you'll accidentally push the whole thing.

I would follow facility policy -it's mostly likely to cover your butt.

[tnbutterfly - Mary, BSN]

Moved to Nursing and Patient Medications for more response.

[subee, MSN, CRNA]

As a CRNA, I share single dose vials every day. I've been through way too may days without Fentanyl, morphine, Versed, neostigmine, Toradol. If we give it, there's been a shortage of it. This is intellectual dereliction to believe that we can't share single dose vials. If a sterile object touches another sterile object, both objects are still sterile. If we carried this poo-poo lack of logic to its conclusion, then we'd have to throw an instrument away after it touched a sterile cavity instead placing it back on the Mayo stand for the next time we needed that instrument for the same case. However, I never double dip into a contaminated container. Those people in LasVegas weren't guilty of poor practice - they were guilty of attempted homocide. It went way beyond sloppy and unethical into a criminal arena. Having said that, in big emergency cases, I just clear off the anesthesia cart because I assume that I can't be diligent during dire emergencies and don't trust my usual system.

[canned_bread]

In our facility, as per protocol, if it is drawn up it has to be given straight away. There is a section for patients own medication (which excludes S6 and S8 drugs) where we can put a drug in there with a patients label on it, and then use that solely for that drug. That is only the vial, not the drawn up medication however. With the scheduled medications, it's a different ball game though for obvious reasons.