Situation: Medication supply issues have resulted in single-dose and multi-dose vials of parenteral medications and local anesthetics available to anesthesia providers. This can present confusion with regard to the utilization and wasting of unused medication.
Background: Medication vials are labeled by the manufacturer based on the intended use.
- Single-dose vials are for one patient, case, procedure or injection and typically lack an antimicrobial preservative.
- Multi-dose vials contain more than one dose of medication and typically contain an antimicrobial preservative. The preservative has no effect on viruses and does not protect against contamination when safe injection practices are not followed.
Assessment: Single-dose vials are preferred over multi-dose vials whenever available. Anesthesia carts are in immediate treatment areas, and surfaces are considered contaminated during a case, resulting in single-patient use and medication waste at the end of the case.
Recommendations:
- Use an aseptic technique for vial access, every time.
- Do not reuse needles, syringes or medication spikes.
- Do not leave needles or medication spikes in vials for subsequent medication withdrawal.
- Single-dose vial of medication is single patient use only, no matter the size of the vial of medication.
- Discard the vial and any unused medication at the end of the case/procedure for which it is being used. Do not store for future use.
- When a multi-dose vial of medication is accessed outside of the pharmacy, it is for single-patient use only, no matter the situation or setting. Any remaining medication must be disposed of at the end of the procedure.
- Example: Multi-dose vial accessed for patient A; vial saved in case an additional dose is needed for patient A during continuous care of the patient. If care is interrupted or ended, any remaining medication is discarded at that time.
- Discard medication vials whenever sterility is compromised or cannot be confirmed.
- When in doubt, throw it out.