Medication Preparation

• Vial


  A small glass bottle with a sealed rubber cap
• Vial types


  • Single-use vials
  • Multiple-dose vials
• Vial


  • Comes in different sizes
  • Has a metal or plastic cap that protects the rubber seal and must be removed to access the medication
  • Medication must be accessed by piercing the vial with a needle
  • Air must be injected into the vial before the medication can be withdrawn

  
• Powdered drugs in vials

  A liquid diluent must be added to a powdered medication before it can be injected
• Reconstitution


  The technique of adding a diluent to a powder drug to prepare it for administration
• Powdered drugs usually have printed instructions (enclosed with each packaged vial) that described the amount and kind of solvent to be added
• Ampule


  Commonly used diluents are sterile water or sterile normal saline
• Single-dose/Single-use vial


  Contains only one dose of medication and should be used only once
• Single-dose or single-use vials are labeled as such by the manufacturer and typically lack an antimicrobial preservative

  
• The safest practice is to enter a single-dose or single-use vial only once so as to prevent inadvertent contamination of the vial and infection transmission
• Do not combine (pool) leftover contents of single-dose or single-use vials or store single-dose or single-use vials for later use
• Medication vials should always be discarded whenever sterility is compromised or questionable
• If a single-dose or single-use vial has been opened or accessed, the vial should be discarded according to the time the manufacturer specifies for the opened vial or at the end of the case/procedure for which it is being used, whichever comes first
• If a single-dose or single-use vial has not been opened or accessed, it should be discarded according to the manufacturer's expiration date
• Multi-dose vial


  A bottle of liquid medication that contains more than one dose
• Multi-dose vials are labeled as such by the manufacturer and typically contain an antimicrobial preservative to help prevent the growth of bacteria

  
• The preservative in multi-dose vials has no effect on viruses and does not protect against contamination when healthcare personnel fail to follow safe injection practices

  
• Multi-dose vials should be dedicated to a single patient whenever possible
• If multi-dose vials must be used for more than one patient, they should only be kept and accessed in a dedicated clean medication preparation area

  
• When using a multi-dose vial, both the needle or cannula and syringe used to access the vial must be sterile

  
• The ONE AND ONLY health campaign is aimed at raising awareness about safe injection practice
• When powdered drugs have been reconstituted, the date and time should be written on the label of the vial

  
• Many reconstituted drugs have to be used within certain time period following reconstitution, so nurses need to know the expiration time after it has been reconstituted
• Following medication preparation, the vials should be stored, in accordance with manufacturer's instructions, in a manner to prevent inadvertent use for more than one patient and/or cross-contamination

  
• If a multi-dose vial has been opened or accessed, the vial should be dated and discarded within 28 days unless the manufacturer specifies a different (shorter or longer) date for that opened vial

  
• If a multi-dose vial has not been opened or accessed, it should be discarded according to the manufacturer's expiration date
• The manufacturer's expiration date refers to the date after which an unopened multi-dose vial should not be used
• The beyond-use-date refers to the date after which an opened multi-dose vial should not be used. The beyond-use-date should never exceed the manufacturer's original expiration date
• Preparing medications from vials

  1. Assess allergies, drug action, client's knowledge, intended route, ordered medication

  2. Prepare materials/equipment

  3. Check MAR

  4. Perform hand hygiene and observe infection prevention

  5. Prepare vial for reconstitution

  6. Withdraw medication

  7. Dislodge air bubbles

  8. Replace needle if giving injection

  9. Label reconstituted multi-dose vial

  10. Store reconstituted medication

  11. Discard materials

  12. Perform hand hygiene

  13. Document