To Swab or Not to Swab......

[Testa Rosa, RN]

Does anyone know what the current practice is regarding alcohol swabbing new single use vials after you pop off the tops prior to drawing up the fluid?

There seem to be two camps of thought:

One says that the vial is sterile since you've just popped off the top and alcohol swabbing is unnecessary.

The other camp says swab everything prior to drawing up meds even on single use vails. The reasoning being that the pop off tops are just there to protect the top not necessarily to keep the top sterile and you should always swab every vial even single use prior to drawing up the fluid.

I was just audited by a very detailed RN who is the "swab everything" camp; Therefore I am now swabbing everything. However, I still see other nurses not swabbing before using single use vials who watch what I'm doing (the gift and curse of being the only new RN on the floor and having a wonderful support) and tell me its unnecessary.

I just want to know if anyone else has any input or research you can point me to.

Thank you, TR

[roser13, ASN, RN]

Curious to see the answers to this. My facility's policy is to swab. I have never thought it necessary to swab, and usually don't.

[Sunny Lioness]

I was taught in school that if you just popped the cap you didn't have to wipe the top with alcohol. However, during my new grad orientation I was told that the tops aren't sterile, regardless if you just popped the top. Out of precaution I began wiping everything with alcohol.

Then I personally discovered just how unsterile those tops can be. I had a patient on compazine and after popping the cap I wiped the top with alcohol and was disgusted by the amount of dirt on the wipe. At first I thought it was a fluke, but it happened on numerous vials. For that reason I am an advocate for wiping everything. Better safe than sorry.

[Not_A_Hat_Person, RN]

I was taught not to swab the top of a new vial.

[SaraO'Hara]

Even if it may not be necessary, swabbing is certainly not harmful. Think of it as an added precaution.

[iwanna]

Hmm.... We were always taught that swabbing a new vial was unnecessary. However, after reading about the dirt on the top of a fresh vial, I will swab all from now on.:)

[Testa Rosa, RN]

I would really want to know a definitive answer as I don't want to be adding this swabbing step if it's not needed. I think I will call the pharmacist on my next shift to see how they weigh in on this topic.

[roser13, ASN, RN]

Please let us know.........

[canesdukegirl, BSN, RN]

I always swab a new vial. The flip cap on a vial is there to protect the integrity of the medication along with the rubber stopper. I don't consider the rubber stopper top sterile. (say that fast 5 times!)

If you are ever in doubt, think about how YOU would want an IV/IM medication administered to you or your family member. It takes 0.5 seconds to swab the vial. Why not do it?

[Jolie, BSN]

It is unnecessary and a potential source of contamination to swab a newly opened vial.

If the seal on an unopened vial is intact prior to use, it is sterile, and therefore swabbing with alcohol is unnecessary. If the seal on an unopened vial is NOT intact prior to use, the entire vial must be considered to be contaminated, and the med discarded without being used.

When you open a sealed vial, you may actually contaminate it by swabbing it unnecessarily if you accidentally touch the alcohol swab to the countertop, your hand or the outer surface of the package. Why take that chance?

[canesdukegirl, BSN, RN]

"Cleanse the access diaphragm of vials using friction

and a sterile 70% isopropyl alcohol,14,17 ethyl alcohol,

iodophor,17 or other approved antiseptic swab.

Allow the diaphragm to dry before inserting any

device into the vial."

This is from Mosby's Pocket Guide to Infusion Therapy.

[Testa Rosa, RN]

Yes, but is that instructions for a single use vial? I know you need to swab the top on multiple use.