Use of Spikes for Multi-Dose Vial Access in Immunocompromised Patients
When using a spike to access a multi-dose vial in immunocompromised patients, you must use a completely sterile spike, cleanse the access diaphragm with 70% alcohol before insertion, avoid touching the diaphragm, and immediately discard the entire vial if sterility is compromised at any point. 1
Critical Sterile Technique Requirements
The following steps are mandatory when using spikes for multi-dose vial access:
- Cleanse the access diaphragm with 70% alcohol before inserting any device into the vial 2, 1
- Use a completely sterile device for both the spike and any associated syringe when accessing the multi-dose vial 2, 1
- Avoid touching the access diaphragm during spike insertion or replacement to prevent contamination 2, 1
- Never reuse a syringe, even if the needle is changed, when accessing multi-dose vials 2, 1
Vial Placement and Contamination Prevention
Multi-dose vials require specific handling to minimize infection risk:
- Keep multi-dose vials away from the immediate patient treatment area to prevent inadvertent contamination by spray or spatter 2, 1
- Discard the entire multi-dose vial immediately if sterility is compromised at any point during spike use or replacement 2, 1
Spike Replacement Timing
When determining spike replacement intervals:
- Replace the spike when 72 hours have elapsed since initial placement, extrapolated from administration set guidelines 1
- Replace the spike immediately if any visible contamination or breach in sterility occurs 1
Special Considerations for Immunocompromised Patients
Immunocompromised patients face heightened infection risks that make strict adherence to these protocols essential:
- Immunocompromised patients account for approximately 3% of the US population and face common complications from infections 3
- These patients include those with HIV infection, solid organ transplants, cancer, asplenia, and those receiving biologic agents or immunosuppressive therapy 3
- Prefer single-dose vials for parenteral medications when possible in this population 2
Common Pitfalls to Avoid
Several dangerous practices must be avoided:
- Never administer medication from a syringe to multiple patients, even if the needle is changed 2
- Do not combine leftover contents of single-use vials for later use 2
- Laboratory studies have demonstrated that viral plaque-forming units can be transmitted to multi-dose vials when a single syringe is used to inject a patient and then withdraw additional medication from the vial 4
Evidence Quality and Context
The CDC guidelines provide the strongest evidence base (IA level recommendations) for these infection control practices 2. While research shows that multi-dose vials can remain sterile with proper technique over extended periods 5, and that infections from multi-dose vials are rare when proper infection control is maintained 6, the consequences of infection in immunocompromised patients are severe enough to warrant strict adherence to these protocols 3, 7.