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Daphne Broadhurst
Split septum vial adaptor

Looking for a split septum vial adaptor approved to remain in a vial for greater than 3 days. Does such a device exist? Please feel free to contact me directly at dbroadhurst[dot]oms[dot]ca.

Many thanks,

Daphne Broadhurst RN, Desjardins Pharmacy

lynncrni
Why would you want to

Why would you want to encourage the practice of using a multiple dose vial for greater than 3 days? This is what has been documented multiple times as practices that lead to outbreaks of infection. It would encourage the attachment of a used contaminated syringe to the vial to withdraw a 2nd dose of fluid. This has been the problem in numerous outbreaks of HBV, HCV and HIV. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

momdogz
Brief excerpt from:  (be

Brief excerpt from:  (be sure to obtain full article) 

The Risks Associated With the Use of Multidose Vials

Author: Susan Paparella, RN, MSN, Huntingdon Valley, Pa

Susan Paparella, Bux-Mont Chapter, is Director for Consulting

Services, Institute for Safe Medication Practices (ISMP*), Huntingdon

Valley, Pa, and a member of ENA’s LUNAR III Workgroup.

For correspondence, write: Susan Paparella, RN, MSN, 1800 Byberry

Rd, Suite 810, Huntingdon Valley, PA 19006; E-mail:
[email protected]ismp.org.

J Emerg Nurs 2006;32:428-30.

Available online 28 August 2006.

Whether medications are stored in an automated

dispensing cabinet, f loor stock, a

supply room, or in a ‘‘kit,’’ multiple-use containers

of injectable medications, commonly known as

‘‘multidose vials,’’ can be found in emergency departments

across the United States. In fact, it is hard to imagine an

ED nurse getting through a shift without using at least

one of the more commonly seen multidose products (eg,

saline solution, heparin, lidocaine, or sterile water). Unfortunately,

this type of packaging often is seen as a ‘‘cost

saving’’ measure by many organizations, sometimes without

considering the inherent risk associated with the use

of multidose vials. Although it is not a new problem,

most practitioners are unaware of the serious infections

that can occur from contamination of these vials.

The Problem

In 2000, the Centers for Disease Control and Prevention

reported that at least 3 patients contracted hepatitis C

from a contaminated 20 mL vial of saline solution that

was used as an intravenous f lush solution.1

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Daphne Broadhurst
I absolutely agree that we
I absolutely agree that we need to minimize the use of multidose vials.  This vial adaptor, however, would be used for the admixture of an extremely costly pulmonary vasodilator & platelet inhibitor parenteral medication that patients will be preparing for self-administration in their home setting, thus not shared between clients. (Single dose containers are not available.) My apologies for not having specified the type of therapy I was referring to.

The recently released "Guidelines for the Prevention of Central Venous Catheter-Related Bloodstream Infections with Prostanoid Therapy for Pulmonary Arterial Hypertension" (2008) recommend, "Access vials with a needle, bevel up at a 45-degree angle, or with a split septum vial adaptor for needleless reconstitution." I have looked for evidence regarding use of an adaptor vs multiple vial entries and thus far have only located an article supporting the Clave adaptor, a luer activated device. Interestingly, the aforementioned guidelines do indicate: “needleless access [for opened vials]: single access with split-septum vial adaptor”, which in looking closer at it, would be cost prohibitive if they have to use a new adaptor each access. I guess this leads to the use of the vial access cannula. Thanks Lynn and Mari for leading me to investigate further. I've also contacted the Pulmonary Hypertension Association for further information regarding these recommendations.

Daphne Broadhurst, Desjardins Pharmacy

Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

momdogz
Ahhh....gets more

Ahhh....gets more interesting.  We see those patients as well, and that med and their line is critical.  Thank you for that article reference; we'll be able to use it.

We used to use the Clave adaptor, for *gasp* (I truly gasp) for multidose heparin flush (YEARS ago!! :-) )  It definitely was handy.  At that time, it was considered appropriate to leave adaptor in the multidose vial for multiple accesses, and I thought for 72 hours, but my memory may be fuzzy about that.

What does your infection control dept say?  I'll be curious about what you discover. 

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Daphne Broadhurst
Unfortunately, we do not

Unfortunately, we do not have an infection control department in the community; hence my literature search. I am hoping to receive further clarification on the use of these vial adaptors from the author of these guidelines. Will let you know if I get a response. If anyone else has any input from their respective infection control teams or published literature regarding multi-dose vial adaptors, I'd greatly appreciate hearing about it.

The complete reference for the guidleines:

Doran AK, Dunbar DI, Barst RJ. Guidelines for the prevention of central venous catheter-related bloodstream infections with prostanoid therapy for pulmonary arterial hypertension. Advances in Pulmonary Hypertension. 2008; 7(1): 245-248

Daphne Broadhurst
Infusion Consultant
Desjardins Pharmacy
dbroadhurst[at]oms[dot]ca

Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

momdogz
I'll forward to our IC

I'll forward to our IC Department; see what they say.

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

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