One of the FAQ I get is this….
Q: Should you or should you not clean the top of vials after you just removed the protective lid?
A: Yes, clean(wipe) the vial diaphragm even if you just flipped the lid off is the answer I give. Then I get this “deer in the headlight” look. Really…? Did you make this up?
Many nurses are under the impression that you don’t have to clean the vial diaphragm (usually gray color) if you just flipped the protective lid but recommendations from APIC Position Paper on Safe Injection Practice is:
Cleanse the access diaphragm of vials using friction and a sterile 70% isopropyl alcohol, ethyl alcohol, iodophor, or other approved antiseptic swab. Allow the diaphragm to dry before inserting any device into the vial.
More recommendations from APIC on vials:
- Always follow the manufacturer’s instructions for storage and use.
- Use single-use or single-dose vials whenever possible.
- Always use a new sterile syringe and new needle/cannula when entering a vial. Never enter a vial with a syringe or needle/cannula that has been previously used (eg, to inject a patient or access a medication vial)
- Discard single-dose vials after use. Never use them again for another patient.
- Discard any vial that has been placed on a contaminated surface or a used procedure tray or that has been used during an emergency procedure
- Use multi-dose medication vials for a single patient whenever possible and access all vials using a new sterile syringe and new needle/cannula adhering to aseptic technique. The risk of viral hepatitis transmission posed by multi-dose vials has been clearly demonstrated and mandates a practice of using 1 vial per 1 patient whenever possible. Infection transmission risk is reduced when multi-dose vials are dedicated to a single patient
- Keep multi-dose vials away from the immediate patient environment
- Never store or transport vials in clothing or pockets.
- Never pool or combine leftover contents of vials for later use.
- Never leave a needle, cannula, or spike device (even if it has a 1-way valve) inserted into a medication vial rubber stopper because it leaves the vial vulnerable to contamination.
- The beyond-use date and disposal of opened multidose medication vials for injection and/or IV administration remains an unresolved issue with differing opinions on the approach. USP ,797. requires a beyond-use date of 28 days after initial stopper penetration (USP chapter unless the manufacturer’s expiration date will be reached before 28 days or the product labeling (package insert) states otherwise. When following USP, date the vial to reflect the date opened and/or beyond use date. Discard the vial when the beyond-use date has been reached.
- CDC indicates that the beyond-use date can be based on the manufacturer’s expiration date. When following CDC guidelines, date the vial to reflect the date opened.
- Regardless of the beyond-use date or manufacturer’s expiration date, a vial should be discarded sooner if the sterility of the product is in question.
- Facilities should develop a policy and procedure for their institution after reviewing and weighing these recommendations, implement an education and competency evaluation program for staff, and consider audits for adherence to the facility’s policy/procedure.
- Inspect vials and discard if sterility is known or suspected to be compromised. Examine the vial for any particulate matter, discoloration, or turbidity; if present, do not use and discard immediately. All vials used during an emergency should be discarded because sterility cannot be
For more information on the APIC Position Paper, click here.
Do you or do you not wipe?? I’d be interested to know your thoughts…please feel free to post a comment!!