ISMP can envision other problems not mentioned in response to the survey when using prefilled cartridges as vials. Nurses may want to dilute small volumes of IV push medications to aid slow administration, or they may want to dilute doses of IV analgesics to speed initial delivery to the patient (rather than remaining in the IV tubing longer than necessary). It is not necessarily the dilution of these medications that is concerning, although in many cases, the dilution is unnecessary given the very few Carpuject medications that actually require dilution according to the manufacturer's labeling (e.g., LORazepam). Rather, the concern lies with the means of diluting them by using a syringe cartridge as a single- or multiple-dose vial. Under these conditions, diluting medications unnecessarily poses a risk that exceeds the benefit, particularly given that the process occurs outside pharmacy-controlled admixture under USP.
Also, transfer of the Carpuject medication in its barcoded, labeled syringe to an unlabeled syringe reduces the effectiveness of a bedside barcode scanning system because the drug and diluent are not in their original, barcoded containers. The barcodes on the original containers might be scanned, but it does not verify that the products are in the syringe used for drug administration since the transfer process often does not occur at the bedside.