Drawing up vaccine from multi dose vial

Multi-dose vials contain more than one dose of a medicine/vaccine in a single vial. Whilst all vaccines on the National Immunisation Program are single-use preparations, BCG vaccines and COVID-19 vaccines are available in multi-dose vials in Australia. Multi-dose vials are more economical, take less time to manufacture and require less storage space than single-use preparations, however, there is an increased risk of infection control breaches associated with their use.

Infection control principles

There is an increased risk of blood-borne viruses or bacterial contamination with the use of multi-dose vials due to an increased risk of cross contamination. These risks can be mitigated by:

• Maintaining standard principles of infection control and strict aseptic technique when accessing multi-dose vials
• Preparing doses of vaccines from multi-dose vials in a clean, designated medication preparation area
• Cleaning the stopper with an alcohol swab and allowing to dry every time the vial is accessed
• Using a new, sterile syringe and needle each time the vial is accessed. Needles should never be left inside the vial
• Discarding a multi-dose vial if the vaccine’s integrity or sterility is compromised

Storage and usage

• Follow the manufacturer’s recommendations for refrigeration, storage, usage timeframes and expiry dates. Protect from sunlight and freezing where required.
• Always label a multi-dose vial with the date and time of first access or reconstitution
• The expiry date is the date after which an unused multi-dose vial should be discarded
• The use by date is the date after which a multi-dose vial that has been accessed should no longer be used. A use by date supercedes the expiry date
• Check reconstituted vaccines for signs of deterioration, such as a change in colour or clarity. If there are signs of deterioration, refer to the vaccine product information. Do not use the vaccine

Multi-dose vials that require reconstitution

• Only the recommended diluent should be used to reconstitute a multi-dose vial
• Introduce the diluent down the side of the vial to avoid foaming or potentially denaturing the vaccine. Mix gently with a careful swirling motion. Do not shake
• Give reconstituted vaccines as soon as practicable after reconstituting. This is because reconstituted vaccines may deteriorate rapidly
• Once accessed, label the multi-dose vial with the date and time of reconstitution

Pre-filling syringes

Pre-preparing syringes with vaccines is not recommended for several reasons:

• The uncertainty of vaccine stability
• The risk of contamination
• Increased risk of potential errors in administration
• Potential vaccine wastage

If you are in a setting where pre-preparing multiple doses is required, then only draw up the number of doses necessary to keep the immunisation session running efficiently. These doses must be labelled with the date and time the vial was accessed and should be used as soon as possible, ensuring that the cold chain is maintained.

Principles of administration

• Attach a new, sterile, disposable injecting needle of appropriate size and length to administer the vaccine
• Be careful not to prime the needle with any of the vaccine as this can increase the risk of injection site reactions
• Administer the vaccine as soon as practicable after drawing it up
• Discard multi-dose vials at the end of an Immunisation session/6 hours after accessing (whichever is sooner) or according to manufacturer’s guidelines
• Refer to the product information to determine the specified timeframe the vaccine must be used by once the vial has been accessed

Resources

• MVEC: Use of Multi-dose Vials eLearning package
• ATAGI guidance on the use of multi-dose vials for COVID-19 vaccination
• ACIPC: Aseptic Technique Clinician Cheat Sheet
• Canadian Immunization Guide: Vaccine administration practices
• Center for Disease Control Injection Safety: Questions about multi-dose vials
• Medical Journal of Australia: Vaccination, consent and multi-dose vials
• WHO policy statement: Multi-dose Vial Policy (MDVP)

Authors: Francesca Machingaifa (MVEC Education Nurse Coordinator) and Rachael McGuire (MVEC Education Nurse Coordinator)

Reviewed by: Francesca Machingaifa (MVEC Education Nurse Coordinator)

Date: March 2022

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.