Both AORN and ASA have voiced in writing opinions against the continued use of multi-dose vials in the operating room. ASA has gone so far as to say they should be banished from the entire operating room environment. Now that two professional organizations have advocated against their use, can regulations be far behind? Also as a matter of medico-legal liability, it would be difficult to defend the practice in light of these recommendations.
It is really a time consuming task, that is prone to non-compliance, to use MDVs in a completely sterile manner. Also the 28 day beyond use dating requirement is not being followed. Old literature stated that contamination was not so much an issue of inappropriate entry (or time that the vial was opened) but of the number of times a rubber stopper was punctured. Rubber material was frequently found floating in the medication vial.
So while a MDV can still be used because that is all we have, it should be used as a SINGLE dose vial. If there is a medication shortage of one of these medications or expense is an issue, pharmacy should dispense the medication as single doses as is now frequently done with succinylcholine.