What are the guidelines for medication use in a single use scenario?

Single-Use Medication Guidelines

For single-use scenarios, all medications and fluids must be designated for one patient only—combining, multidosing from a single vial, or using drawing-up bags between patients is unacceptable. 1

Medication Preparation and Handling

Drawing Up Medications

• Draw up medications immediately before use, not in advance 1
• Clean glass ampule necks and rubber caps with 70% isopropanol (with or without chlorhexidine) and allow to dry before inserting a drawing-up needle 1
• Note that exterior surfaces of most injection vials are not sterile and require cleaning 1

Propofol-Specific Precautions

• Propofol supports bacterial and fungal growth, promotes endotoxin production, and maintains viral stability 1
• Higher contamination rates of syringes, IV lines, and stopcocks occur when propofol is used 1
• Single-patient use is mandatory—never reuse propofol vials or syringes between patients 1

Syringe Management

Contamination Prevention

• Any contact of syringe tips with fingers or surfaces dramatically increases contamination rates 1
• Cover tips completely with sterile caps or blunt needles 1
• Use alcohol-impregnated cleaning caps for male Luer-tip connectors and needleless syringes to reduce stopcock contamination 1

Disposal Timing

• Discard used syringes immediately after use 1
• All syringes must be discarded by the conclusion of each case 1

Emergency Drug Preparation Exception

If preparing emergency drugs for later use (the only acceptable scenario for advance preparation):

• Label each syringe with medication name, concentration, date, time drawn up, and preparer's name/initials 1
• Store according to local guidelines in a secured area 1
• Each person on shift should draw up their own emergency drugs rather than sharing 1

Access Port Management

Before Each Use

• Disinfect ports with alcohol wipe (with or without chlorhexidine) for 15-30 seconds using friction 1
• Allow to dry completely before accessing 1
• Use commercially available disinfectant caps to increase compliance and reduce central line-associated bloodstream infections 1

After Each Use

• Flush access ports and lines clear of blood or residual medications, especially propofol 1
• Cover open lumen ports with sterile caps when not in use 1

Common Pitfalls to Avoid

• Never place ampules, broken glass, pens, airway equipment, or dentures in anesthetic drug trays 1
• Never assume vial exteriors are sterile—always clean before accessing 1
• Never save partially used vials or syringes for later use on the same patient—this violates single-use principles 1
• Avoid open lumen devices when possible, as they are difficult to decontaminate and increase contamination rates with frequent accessing 1