Society of Interventional Radiology position statement on injection safety: improper use of single-dose/single-use vials.

Efficient health care delivery includes expense reduction, distribution of limited resources, and minimization of medical waste. These goals must be achieved without patient safety compromise. One challenging example is the administration of injectable medications. Some common procedures may require injection of only a small quantity of medication such as sodium tetradecyl sulfate (Sotradecol; AngioDynamics, Queensbury, New York), onabotulinumtoxinA (BOTOX Cosmetic; Allergan, Irvine, California), or radiocontrast agents for arthrography, myelography, or percutaneous pain management procedures. In a busy clinical setting, with several consecutive patients scheduled for similar procedures, it may be tempting to purchase a medication in a large ‘‘economy-size’’ container and split the doses into multiple syringes for administration to multiple patients. An essential feature of injection practice involves the safe administration of a medication packaged in a single-dose vial (SDV) or singleuse vial. The Centers for Disease Control and Prevention (CDC) note that improper use of a medication packaged in an SDV can place a patient at increased risk for acquiring a health care–related infection (1). Medication from an SDV is intended for parenteral administration for a single patient during a single procedure. SDVs are labeled as such in the manufacturer’s package insert. The CDC states that SDVs must not be used for multiple patients. Even if an SDV contains more medication than is needed for a single patient, that vial should not be used for more than one patient nor stored for future use in the same patient. In contrast with an SDV, a multidose vial (MDV) of a medication contains more than a single medication dose. MDVs are labeled as such by the manufacturer and typically contain an antimicrobial preservative agent to help prevent bacterial growth. The preservative agent has no effect on viruses and does not protect against contamination when health care personnel fail to follow safe injection practices. MDVs are discarded within 28 days unless the manufacturer specifies a different (shorter or