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Discussion in 'Pain Medicine' started by drpainfree, Sep 23, 2011.
how long do you guys keep opened 5ml depo-medro vial?
ideally only for the day... .. but definitely everything opened is thrown out on friday...
the spine vials are pitched daily. meaning its opened new in the am, and then tossed if any is left over at the end of the day... the ones for TPIs and bursas, shoulders usually get used up quick, within a day or two, but never more than 3-4 days...
although i use kenalog only now, but same thing
Throw it out at the end of the day.
Until I use the last drop, whenever that may be.
Fixed it for you.
Ha. Seriously there has been no infection in about 40 years of combined practice. If someone really has a concern, that is good information to know. It's not like that stuff sits open for a month, but if you open a bottle on a Friday its still good on Monday.
Sure, but the SOC is to throw it away and the CDC guidelines state it so.
If you were to get an infection, you'd be out of a job in the procedure suite sa the medical board would restrict your license.
It really needs to be mentioned that during a case, if you you wish to draw more medication, you need a new needle and a new syringe to re-draw out of the same vial. EVERY TIME.
Thanks for the info. However it cited two main reasons for infection. Reinserting used needles into MDVs and using the same needle for multiple people. I don't know who is going to be that big an idiot, but going so far as to say you must throw away a MDV for those above reasons is a stretch. The CDC says discard if sterility is a question, like that isn't common sense. It doesn't say you have to pitch at the end of the day.
You could use vaccine guidelines and keep a MDV for 28 days, as long as you never accessed it with a needle or syringe that was already used to draw up medication for any reason. But I do not recommend this. All bottles should get thrown out at end of day.
Some fun reading on what not to do:
the question was NOT about using the same needle to access the MDV for different patients.
it's about sterility issue. propofol is known, for example to have increased rate of infection if it's opened for more than 3-4hrs. does depo-medro have the same problem? anyone has any scientific information on this?
Depomedrol multidose vials contain a bacteriostatic preservative that helps prevent infection or bacterial overgrowth. Benzyl alcohol is effective against both gram positive and gram negative organisms but myristyl-gamma picolinium chloride is ineffective against the gram negative serratia marcesens. Both multidose (benzyl alcohol) and single dose (MGPC) contain antimicrobial agents. The MGPC is mildly neurotoxic and the benzyl alcohol is moderate to severely neurotoxic. The alternative is use of multidose celestone but this contains benzylalkonium chloride, which is highly toxic to chondrocytes.
The CDC has taken a ridiculously hard line on multidose vial use that is not supported by scientific literature. Using a non-preservative containing solution such as Omnipaque along with new needle/new syringe for every access along with alcohol double wipe of the vial prior to accessing has prevented infection in my practice for the past 15 years. We use the vials for a month. Multidose vials should have no higher infection rate than the non-preservative containing vials, therefore using the measures taken above, there should be no cause for infection in the multidose vials. Because of the concern about serratia, found in some epidural abscesses, use of single dose vials for multiple uses may be questionable.
Diprovan is a potent growth media for bacteria due to the presence of a very weak antimicrobial, 0.005% disodium edetate, whereas the sodium metabisulfite containing Baxter formulation may be slightly better. The egg lecithin is one of the major growth media, something absent in Depomedrol. The MSDS Pfizer for depomedrol does not list bacterial growth characteristics and there is not much in the medical literature examining this either.
In retrospect, using non-preservative containing compounded drugs may be profoundly hazardous as was seen in the past with population infections due to contaminated depomedrol. Most compounding pharmacies today will not compound without preservatives, but will include MGPC in their compounded steroids, but call them "preservative free", an inaccuracy.
For more info, see Clinical neuromythology and other arguments and essays, by William Landau.
Hospitals in my area will no longer allow MDV to be used on more than 1 pt, 1 day. New bottle every pt, no matter how much drug gets thrown out. One could assume this could be used as the community "best practice" in cases where the SoC is not easy to define.
Nah, it is CYA mentality of hospitals that really don't give a hoot about patient care costs, cowed by FDA nonsensical proclamations, and may be due to something much more mundane: the hospitals cannot figure out how to equitably charge for split vials. There is no mechanism for that in some hospitals. If doctors use the same perverse mentality hospitals use as a community standard, then we are all doomed to practice to JCAHO BS standards in our offices. No thank you.
Agree with algos,
Standard of care is real medical literature, or at a minimum how respected colleagues practice medicine based on existing evidence.
Hospitals have hundreds of rules, rule books, and pointless meetings created by people trying to justify their positions.
I reuse my contrast bottle until it's gone, top is swabbed with alcohol between uses. One bottle is never open more than 30 hrs, as I use more than one per day.
All my steroid comes preservative-free in 2ml vials. I might split them between two patients on the same day, but usually one vial per patient