Are multi use vials safe as long as a new needle is used every time?
Multi use vials : Are multi use vials... - Pernicious Anaemi...
Multi use vials
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Ctadds1
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Not advisable because there are more risks. Individual vials are the safest.
The safest is single use ampoules. Even with the greatest care once opened it can get contaminated.
They are used by some.
I woukdnt personally use them.
Not sure why they are made now. ?
No, still not recommended.
The problem scenario is this -
You swap the top of the vial with an alcohol wipe, thus removing all the bacteria, fungi, etc. on the top of it (If you don't do this bit then it's really dangerous). Then you open the needle from its sterile packing and wave it around in the air, where bacteria, fungi, etc. can land on it.
Then you stick the needle in the vial and possibly transfer the bugs into the liquid. If it's a single-use ampoule then it's no real problem, your body's defences can handle the odd interloper. But if it's a multi-use vian then the bugs will stay swimming around in the liquid - and growing.
The next time you use the vial you could be injecting millions of bugs. Which is not a good thing.
"The next time you use the vial you could be injecting millions of bugs. Which is not a good thing."
And would there not be an infection over time? A fever? Possible sepsis?
What would the signs be? Would it not show up somehow in one's bloodwork, in close proximity of time?
Simply curious.
***** Anyone? I would love this question answered. *****
"Then you open the needle from its sterile packing and wave it around in the air, where bacteria, fungi, etc. can land on it."
I am assuming your waving around is a tad facetious, yes?
My question is - Does a medical professional do something with the needle/syringe that a layman is not doing as much, for safety purposes. Trying to deduce whether you are making a separation in thought between a medical professional and someone at home, with the handling of a needle.
Medical professionals will not use a multi-use vial under those circumstances. They will use single dose ampoules.
The only time they would use a multi-use vial is when the contents are all going to be administered in a very short time - as with covid-19 vaccines. Then any bugs that may have contaminated the needle will not have time to grow in the liquid.
The medical professionals at my GP's office 100% use a multi-use vial for b12 shots.
As they do in others' GP's offices in Canada, well Ontario at least.
-+++++++++
So you were not suggesting that medical professionals are more skilled at keeping the needle safe, with multi-use vials? No sarcasm meant. I am and was trying to figure that out.
I think, only guessing in the scenario you depict. They may be running a clinic for b12 shots so it will be used very quickly for multible shots .So professionals will just uses them up very quickly in a clinical setting.
Wearsterile gloves ect.
Drug fridges free of food.
Only my thoughts and observations.
Otherwise are discarded.
I would chooses a single ampoule every time.
Single ones are used all of the time in the UK.
It's lije going back in time using a multiple doses ampoule.
Not sure why they are made.
Why take the risk?
For me it is not a risk because it is common practice here Nackapan (I thought I pressed a direct reply to you! EDIT: How strange now the formatting is working and it has bounced back up.)
But the reason is cost and ease. I can get a ten shot multi-use vial for $5 by walking into any pharmacy. Five dollars is my cheapest find, some pharmacies charge as much as $8. If I had a larger budget I would probably order single use vials.
(Nackapan, it is crazy wonderful your difference in typing over the past year! Noting it just in case you don't notice the difference yourself. It is a change in light sensitivity? Cognitive changes? I am still leaving full words out of sentences, and not noticing on the first or second edit. But remaining hopeful.)
I think less headaches and very gradual improvements . Also am able to look at the screen longer before tinnitus and pain in my eyes take over. The text still disappears from the right but I think I'm more practised.
I used to try and type quickly before it disappeared.
All bizarre.
Also found the edit button. Iol
Light sensitivity still a problem .
I'm trying not to avoid lights but very tempted tk do so now tgd days are longer.
Winter was miserable as its wo winters now
Hope you are still making improvements too.
No.
I am saying that medical professionals will not leave a multi use vial incubating the bugs for weeks. If they use multi-use they will have strict guidelines on how long they can use it after furst use.
Things are done differently I think in the US and Canada than the UK. Multi dose vials are commonly used in the US medical practice. They have preservatives in them to allow for this but you must look at the package insert to see the requirements. Usually keep in fridge or freezer, swab with alcohol each time and generally discard each month. So they can be used for those that administer weekly or biweekly. PS, I am a Pharmacist.
The USA's CDC has this advice:
cdc.gov/injectionsafety/pro...
The very fact that they need to put this out implies they have concerns over the use of multi-dose vials.
I have used multi-use vials for a year and a half, when I self-inject. I throw them out after 28 days regardless.
All doctors' offices in Canada use multi-use vials for b12 shots, for their patients. Well in my province at least.
Now before you say but they probably use them quickly - My sister's office has their patients bring in their own multi-use vials, which is insane because therefore there is no throwing out at 28 days. They use the same vial over a long period of time, given that the protocol for cyanocobalamin is a month. And honestly I don't even get that suggestion, who cares where the separate single-use needle goes in a multi-use vial? (Not debating if a single use vial is a better choice with that thought. It most definitely is) It is really late here, what am I missing with that specific scenario?
And multi-use b12 vials are sold in pharmacies across Canada.
publichealthontario.ca/en/h...
Ontario's thoughts on multi-use vials.
They note at the bottom that single-use are
always preferred.
But they are not used in clinical settings here, nor from pharmacies. Like I said it is all multi-use. The nurse has shown me the vial as we have two manufacturers of cyanocobalamin here, and I was curious which one they use.
I am relatively sure that at my GPs office doses are taken out of the vial for different patients, just like a vaccine vial has multiple doses.
And if there truly is a multi-use vial there just for me and no one else - like the recommendations state (there's not), well there is no way it is thrown out after 28 days, as we go in once a month. So round and round we go!
Yes interesting that some vaccines are single doses vials and others are not. In my last job assisting in vast school vaccination roll outs single ones were always used ...always I had to count and collect from the pharmacy and record batch ect .
It's all down to money. Multi doses vials are cheaper.
In the pandemic quicker to produce and Cheaper than single filled syringes.
Same for b12 but that's so cheap anyhow??
To me it's like going back to using a ink pen and blotter.
Nothing changes or moves quickly with pharmacy supplies and b12 probably bottom of the pile as usual !
It's all down to money. Multi doses vials are cheaper.
It might not be solely down to money. The availability of the materials (specific types of borosilicate glass) and other materials have affected the entire roll-out process. And the rate at which the vaccine can go through filling and finishing. I'm sure there are other reasons as well for multi-dose.
Sorry what does your reply mean. Max?
I use multi-dose vials in both my professional career and in my own personal life, and as long as I’m preparing and injecting in a very clean way, there are no problems. The downside to multi-dose vials are different things have different handling/storage rules, along with expiration times. My B-12 comes in a 10ml vial, does not require refrigeration, but has to be used within 30 days of the first needle puncture. For me that’s not an issue at all. I have a very careful practice for drawing up my dose as to avoid contaminating the vial, either at work or here at home. For me, it’s a matter of price when deciding to use multi-dose vials, as I can’t afford single dose vials, but if I could switch I would do it in a heartbeat, because the risks would not be there.
How do the costs differ between single-dose and multi-dose vials?
Well taking cyanocobalamin for example, 10 1ml vials is $40 from where I get it. 1 10ml multi-dose vial is only $16. Much cheaper. That’s the same with single dose vials of meds that we use in healthcare, specifically morphine, dilaudid, succinocholine, solumedrol, those are expensive for one dose vials, but they’re stocked in the hospital and on our ambulances because we won’t have to worry about keeping tabs on the date and time a vial was opened. They just bill insurance for the amount and it usually gets paid. That’s why if you’ve ever been in the hospital (in the us) and seen outrageous fees for pharmacy.
Every naturopath in my community uses multi-use vials for B12 and B complex injections. I use multi-use vials prescribed by my naturopath. I've never questioned this because they are prescribed that way from a reputable compounding pharmacy. There is a small amount of benign preservative in the bottles of B12, and I assume it's to deter bacterial growth, but I also use injectable Thiamine HCL that is preservative free and sold as a single-use vial. The compounding pharmacy told me that if I am very hygienic (alcohol swab the top, clean hands) and store it in the fridge, it shouldn't be a problem. In the year I've been injecting using multi-dose vials, I've had no problems. I'm assuming if this practice were an issue, I would have heard about it by now, as many people I know get B12 injections from the naturopaths in town. Many vaccines are also in multi-dose vials.
The compounding pharmacy can say what they like! I'd be more likely to take note of what the USA's CDC say about single-dose vials:
Even if a single-dose or single-use vial appears to contain multiple doses or 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 on the same patient.
cdc.gov/injectionsafety/pro...
The key is that line “single dose”. Manufacturing requirements for single dose and multidose vials are different. Single dose should only be used once because there isn’t a preservative. Multi dose is meant to be used and punctured multiple times as the name implies and contains a preservative for that very reason.
Yes, I do appreciate the difference in formulation of single- and multi-dose products - I had earlier linked to the USA's CDC re multi-dose wherein it states:
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 has no effect on viruses and does not protect against contamination when healthcare personnel fail to follow safe injection practices.
The post I was responding to included:
... I also use injectable Thiamine HCL that is preservative free and sold as a single-use vial. The compounding pharmacy told me that if I am very hygienic (alcohol swab the top, clean hands) and store it in the fridge, it shouldn't be a problem.
My point was that I would not trust the say so, likely undocumented, of a compounding pharmacy over that of the CDC re multi-dosing from a single-dose vial.
We don’t use multi-dose vials in a domestic situation for the same reason we don’t use catering packs of double cream.
I have used a multi-use vials of hyrdroxocobalamin obtained at US pharmacies for well over 4 years without problems. Just be sure to refrigerate properly and dispose of the vial within 28 days as directed by the pharmacy. I previously used unrefrigerated vials for up to six months because I didn’t know any better. The label doesn’t indicate this since the vial is packaged for the clinic setting and the assumption is that it will be used quickly. The problem I had was a reduction in the potency of the b12 and I had a relapse of symptoms. A pharmacist helped me discover the cause of my problem when she noticed I wasn’t filling my rx every 30 days. I have received b12 injections in a lab and it also used a multi-use vial that wasn’t refrigerated, but it was likely being used up in under 28 days. I have used single vials of cyano, but single vials of hydroxo or even smaller vials than 30ml are not obtainable at US pharmacies. It’s pretty common in the US for type 1 diabetics to use multi-use refrigerated insulin vials and that has been the case for many, many years. My mom is a type 1 and I grew up watching her use multi-use insulin vials daily without issue. I would imagine that even more care is warranted with use of multi-dose vials in the clinic setting (CDC guidelines) since different patients are receiving doses from the same vial as opposed to just one person accessing the same vial for personal use only.
Totally off-topic, but pharmacists are the best. I have learned more from them than any doctor over the years.
And a pharmacist wiped any apprehension I ever had about self-injecting. By letting me know that the warnings are there for our protection, but sometimes they are not the huge deal they are made out to be. Like hitting a small blood vessel.
And I am not arguing refrigeration with this statement but it says right on the insert of our multi-use vials that they do not need to be refrigerated, but to store in a cool dark space.
That’s exactly what I thought, too since the bottle doesn’t state it should be refrigerated-but then again my B12 is packaged for clinic use. I asked my neurologist about the lifespan of the multi-use vials and she said, “I don’t know, ask the pharmacist, but you’re refrigerating it, right?” I wasn’t but I did after that. Makes sense that refrigeration would help preserve potency and perhaps discourage bacterial growth, but probably doesn’t matter as long as the vial is tossed every 28 days. I think I’m just especially cautious after not refrigerating and using the same vial for 6months and suffering a relapse. I want to do anything I can to help preserve the potency of the b12. I even wrap the bottle in aluminum foil to protect from light in the fridge.
I used 30 ml multi use vials for about 12 years. Since I injected myself daily I had no problem finishing it in a month. I can see why single use vials would be much safer in a hospital or clinical setting with so many different people around, nurses, doctors and patients and other staff plus the speed at which they are required to dispatch their duties, not to mention the great opportunity for bacteria and all kinds of bugs to be floating around but at home in a relaxed setting with usually just family and friends coming and going I am sure it is much safer. At the time I was using injections, which started about 22 years ago, it didn't occur to me there was a safety risk. I don't think there were single use ampoules at the time. I just kept it in the frig and took it out and used it. I never had any problem. I used sublingual for the remaining 12 years which worked just as well, though I used 5000 mcg instead of the 1000 mcg injection. Now the sublingual isn't working. Don't know why and so I am going to try injections again, SI since I can't get a prescription for injections as I rate high in B12 in my bloodstream even though symptoms that I associate with being deficient in B12 from experience are gaining on me daily. I have ordered and received the single use vials but my preference would be for the multi use if I can find it. And yes money is an issue. Multi use is much cheaper and I use alot of it with daily shots and there are the syringes and needles to buy. If I have an expensive B12 program to maintain I might not have the funds to keep maintenance up on my car. Poor and living in the USA 
First, how I love your name!
Have you used different forms of b12 over the years, with self-injecting and sublinguals? Curious if you have and if so, do you personally take to one more?
From our provincial guidelines, if one is using a multi-use vial - "Use a multi-dose vial for a single patient whenever possible and mark the vial with the patient’s name."
This is something I have never ever understood. Have I gone cuckoo for cocoa pops? You are putting a needle into a multi-use vial. That needle is new and doesn't know or care what arm it goes in.
In fact, the more people that you use for a multi-dose vial, the better - it is thrown out in less time. In my GP's office either way it is only the nurse that touches it.
This has to be about past legalities or something I am missing. If not, the people who decide on these guidelines have been smoking something.
Or am I Iosing it?
If you are using them to SI B12 to just yourself, multi-dose vials are completely safe to use as long as proper aseptic technique for drawing and administering is followed. I use 30ml vials and SI daily. I write the date of first draw on the vial and discard after 30 days maximum. Store the vial in a cool, dark place to reduce product degradation due to excessive light and temperature or per the manufacturers recommendations. That is why the vast majority of B12 is supplied in dark amber vials. Use one sterile needle to draw the dose and another to inject. If you cannot learn or practice aseptic technique, by all means PLEASE use single dose vials, but you also should not be self injecting IMO. I cannot speak to costs outside the United States, but I pay just over $20.00 for a 30ml vial of hydroxo with an Rx written by my GP and filled at a local pharmacy. I also have a backup Rx of cyano single use 1ml vials for cases where I have injected more than once per day when symptoms are severe. Ten 1 ml vials cost $42 at the same pharmacy.
For full disclosure, I do have extensive training in nuclear medicine, radiopharmaceutical compounding and administration, so I am very comfortable handling and injecting medications. You may not feel so comfortable, so please do whatever makes the most sense for YOU from a medical and financial perspective.
Thank you so very much for all the comments. I am curious if anyone on here has ever experienced any issues with multi use vials ??
I gets shots weekly. Less than that and I fall apart. My doc will only give them to me every other week and the doctors office uses single dose. On the opposite weeks I go to a medi spa type place where a registered nurse gives me injections and she uses multi use vials that she uses for all her patients. I believe there is about 30 injections (1000 mcg) per multi use bottle. She probably goes through this pretty quickly. She has offered to let me purchase my own bottle w/syringes so I can self inject. I have considered this but since I only would SI every other week I would not go through a bottle very quickly. The nurse said it would last me awhile and that it would be fine but it sounds like most on here throw it out after a month. One bottle could potentially last me a year. It sounds Iike that would be way too long to use a multi use bottle ??
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