Single-Use Vials -- The Debate Continues

Laura A. Stokowski, RN, MS

Disclosures

December 11, 2012

In This Article

Pharmacists Weigh In

Officially, professional pharmacist organizations agree with CDC's position on appropriate use of single-use vials. Indeed, most pharmacists who contributed to this discussion voiced support for the single-use vial guidelines.

"As a pharmacist trained in aseptic technique in hospitals, I cannot understand why nurses or physicians advocate reuse of needles, syringes, vials, or any contaminated equipment on different or the same patient. Working in the vertical flow laminar hood, we don't even use the same needle to draw up drug from the same vial, and to think that healthcare providers even use the same needle (or syringe) to withdraw from the same vial in the open air to inject directly into a human being is completely disgusting. Some pharmacists will consider reusing single-dose vials if kept in the hood with no evidence of obstruction of the airflow (which maintains the aseptic integrity of the punctured vial), but I usually throw them away at the beginning of my shift unless there is a guarantee that no flies flew by."

Answering this question from a nurse, "How do you charge for more than 1 dose from a single-dose vial?" a pharmacist wrote, "Some hospitals charge the patient (the third party) by what is documented as administered in the electronic medical record. The system is set up to charge a single-use vial each time a dose is administered, so each time you document a dose as being given, you are charging for a full vial. There is a name for reusing a vial and charging for a new one and that name is fraud."

Another pharmacist contends, "Repackaging medications according to USP<797> guidelines is the key to extending the supply of medications. Competent compounding pharmacists can provide this service. USP<797> guidelines require sterility testing of the repackaged products. This should be done on every batch. You should definitely consider a PCAB (Pharmacy Compounding Accreditation Board)-accredited compounding pharmacy that can provide you with test results to ensure that you have a quality sterile product. Appropriate package sizes are available if proper stability data are available."

Because so many clinicians voiced concerns about the waste involved when a single-use vial contains more drug than is needed for the patient, another pharmacist commented, "Many caregivers worry about wasting drugs that cost less than a dollar. This is penny-wise-pound-foolish. The place to save money is in prescribing -- eg, choosing less expensive drugs (usually not the latest on the market), evaluating risk-benefit, and checking with patients and family members to determine whether it is prudent to use a $25,000 drug that will not significantly extend or improve quality of life."

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