Vial Flip Caps 

Extract from post on Infusion Nurse Blog, 2/3/2016, reprinted with permission. (See infusionnurse.org for the complete posting.)

Sample Vial with Flip Cap

Q: I was always told back when I was a nursing student, that if you’ve just removed the flip cap from a vial, the vial rubber port is sterile and does not need to be disinfected prior to access. So I just insert the syringe to withdraw the medication. For vials already opened, I do swab with alcohol prior to use. Should I be swabbing the vial rubber port even if I have just removed the flip cap covering? (signed: an old nurse but not as old as Florence)

A: Please know that you are not the only one who has been under the impression that the pop-off caps (or flip cap) on vials keep the vial diaphragm (rubber port) sterile. And as such, when the cap is popped off, many nurses do not disinfect the diaphragm before inserting the needle to withdraw the medication. Sad to say there are still many nurses and other healthcare providers who believe this as true.

Since you asked, here’s the answer.

• The Association of Practitioners in Infection Control and Epidemiology (APIC) states in its position paper entitled “Safe Injection, Infusion and Medication Vial Practices in Healthcare”: Cleanse the access diaphragm of vials using friction and a sterile 70% isopropyl alcohol, ethyl alcohol, iodophor, or other approved antiseptic swab. Allow the diaphragm to dry before inserting any device into the vial.*

• Institute for Safe Medication Practices (ISMP) in its “Safe Practice Guidelines for Adult IV Push Medications” publication explains: The “pop-off” vial caps from manufacturers are considered “dust covers” and are not intended to maintain sterility of the vial diaphragm or access point. Thus, the diaphragm must always be disinfected after removing the cap of a new vial. **

And while we are talking about “vials”…about the open vials you mentioned—please keep these APIC recommendations in mind.

• Always follow the manufacturer’s instructions for storage and use.

• Never pool or combine leftover contents of vials for later use.

• Date opened multidose vials to reflect date opened and/or date of expiration.

• Inspect vials and discard if sterility has been, or is thought to be compromised. Examine the vial for any particulate matter, discoloration or turbidity. If present, do not use and discard immediately.

*Source: www.premiersafetyinstitute.org/wp-content/uploads/APIC-SafeInjections-final.pdf

**Source: www.ismp.org/Tools/guidelines/ivsummitpush/ivpushmedguidelines.pdf

LifelineLetter, March/April 2016

Updated 8/16/16