Single use vials - told by admins to use as multi-dose

[rofner]

Help!! My patient receives 1 ml IV Lasix x3/day. The institution recently changed pharmacies and instead of 1 ml vials, we now have 2 ml single use vials. Since the patient's dose is 1 ml, I was told to save the vial with remaining 1 ml for the next dose. According to the CDC, this is not proper practice. I have sent the director of nursing the link to the CDC page but anticipate being told to continue using the single dose vial as a multi-dose vial.

Should I refuse to do this and, if so, how do I refuse and still keep my job? Help!!

[MissKayRN]

Is there an infection control nurse or department at your facility? If so, they usually call the shots on matters such as these and rather than trying to cut costs, they always lean towards the most cautious measures. Any time I have a question about something like this, I head to our infection control nurse and she quickly resolves the issue and implements new policies.

[NRSKarenRN, BSN, RN]

safe injection practices under standard precautions the practice

cdc - syringe reuse - injections safety

...a single-use vial is a bottle of liquid medication that is given to a patient through a needle and syringe. single-use vials contains only one dose of medication and should only be used once for one patient, using a clean needle and clean syringe.

a multi-dose vial is a bottle of liquid medication that contains more than one dose of medication and is often used by diabetic patients or for vaccinations. a new, clean needle and clean syringe should always be used to access the medication in a multi-dose vial. reuse of needles or syringes to access medication can result in contamination of the medicine with germs that can be spread to others when the medicine is used again.

whenever possible, cdc recommends that single-use vials be used and that multi-dose vials of medication be assigned to a single patient to reduce the risk of disease transmission.

healthcare providers should always adhere to safe injection practices under standard precautions to prevent disease transmission from needles, syringes, or multi-dose vials.

in these days of drug manufacturing shortage, using a single dose vial for same patient with 2 doses being administered within 24hrs of vial being accessed would be acceptable, although not ideal, and drug does not have to be reconstituted when mixed in specific time frame as preservative free.... ok in this lasix scenario. new syringe and needle for each dose.

be sure to document your phone call to pharmacy questioning practice to cya.

[NamasteNurse, BSN, RN]

not worth losing sleep over! :)

[LylaRae]

Average Costs – U.S.

• 40 mg/4 ml vial for injection (generic)

ALS Service cost: $1.42 each

Large Hospital cost: $0.65 each

Definitely not worth losing sleep over.

[Creamsoda, ASN, RN]

Or you could just carry on as normal and only use one vial per dose who care what they say, best practice is best practise, just get pharmacy to back you up

[fhaq]

Can anyone tell me how you post

[nursejoed]

The facility bills the medication charge regardless- I don't understand how this saves money unless they're billing for two vials while you're only using one for two dose times- that would be fraud.

[BabyLady, BSN, RN]

We have single-use vials of Lasix that we use for a 12-hour shift if it requires multiple administrations. Other medications as well.

We only use it for one patient.

Clean needle/syringe with each access PLUS Chlorohexidine before access to the vial.

[rofner]

Ok, so here's the update. I worked on the weekend, no admins around, and informed my supervisor of the dilemma. She agreed with me that I couldn't save the unused portion of the vial. However, she told the next nurse coming on shift that she should draw up two doses using the same needle and save the second dose to use later. This was wrong information.

All this came about because the on-site pharmacy that our facility used is being transitioned over to an off-site pharmacy. The new pharmacy is using a different brand of Lasix than the on-site pharmacy. The on-site pharmacist has been coming in during this transition phase and I went to her with the entire story over the weekend. She placed a call to the manufacturer of the second brand of Lasix who sent her a letter that she then distributed to all of the admins, including the Administrator of the nursing home. The letter said that not only should the vial be entered only one time, but that the drug should only be considered stable for one hour once drawn up.

I'd like to thank everyone that replied for their support. I feel vindicated but also feel terrible that it took a relatively new nurse to do the right thing by my patients (got my license in 8/2009) and that so many others were prepared to not only use this drug in the wrong way but that so many other nurses were prepared to go along with it although they knew it was wrong. I guess this was a wake-up call for me. Anyway, thanks again :)

[rofner]

Believe it or not, it was the infection control nurse that told me to reuse the single use vial. I know - amazing. And she told it to me in a voice that called me an idiot for even questioning her. lol