Splitting contrast vial between patients?

[stonemountain]

Because contrast is so expensive and the vials are so large, I have been splitting one vial of Omnipaque 240 20 cc ( will soon be using 50cc vials since they are chaper) between patients for the day. I always draw up with a new needle and syringe (never draw using a used needle or syring) so there is no issue with spreading infectios between patients.

However, the news story in Las Vegas has me rethinking this. We are moving towards using only one vial per patient, and wasting the rest (45cc). Because of the increased cost, we will have to start charging the insurance for each vial of contrast.

I was wondering whay everyone else is doing?

http://www.cdc.gov/ncidod/dhqp/PS_SyringeReuseFS.html

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[Tenesma]

i have moved towards having the RN draw up all of the contrast in the AM into 3ml syringes with extensions already primed to go - all in a sterile fashion... what isn't used by the end of the day gets dumped...

 

[PMR 4 MSK]

I draw up everything myself - too many nurses who still don't have the sterility thing firmly in mind, even at an ASC. We use multi-dose vials of local and contrast, not of steroid. If I haven't kept my eye on it the whole time, how do I know sterility was maintained?

We use the bottle on a second patient, if on the same day, but always use new needles and syringes of course. This was brought up to the surveyors for our recent AAAHC, and that is permissible to do.

I've often wondered, though, how long bottles can be kept once opened, such as for my clinic, we may have a bottle that takes a few weeks to use up. There does not appear to be a standard for how long after being opened and canulated a bottle can be kept. These are for TPI's, joints, etc.

 

[Pain_doc]

Multi-use vials are supposed to be dated & initialed and discarded after 30days (this is per state board of health & Jcaho). The surgery center and hospital where I perform injections discard all opened medications at the end of the day. I will not use vials that had previously been opened by others, as I'm not that trusting.

With regards to office procedures, I was under the impression that the Q code for contrast was per ml used.

 

[knoxdoc]

Not to change the subject, but does anyone have the codes for procedural meds (i.e. contrast, Kenalog, Marcaine, Lidocaine, etc)? I just started doing office procedures and it would be great to get a few bucks for all those expensive meds.

 

[Pain_doc]

There's a website where you can search for the codes

http://www.icd9data.com/hcpcs/2008/J/default.htm

 

[knoxdoc]

Thanks Pain-doc.