Changing needles prior IM injection - page 3

What is your current practice in reference to changing the needle prior IM injection after withdrawing the medication from a vial? If you change the needle after withdrawing medication prior use on... Read More

  1. by   suzanne4
    Don't you use insulin syringes that have a built in needle and cannot be removed? Or were you using a TB syringe?
  2. by   Dayray
    Quote from suzanne4
    Don't you use insulin syringes that have a built in needle and cannot be removed? Or were you using a TB syringe?
    This was a few years ago and at that time the needles could be changed out. Now they are all built in. I don't give much insulin anymore so I'm not sure how I would handle that situation if it came up now. I do give some SQ's but the meds are in ampules so no need to go threw a rubber stopper.

    For IM's I actually have to open another syringe because they don't stock extra needles on my unit.

    I would never draw up insulin in a TB syringe, although I have seen some other nurses do it. 1 insulin unit is not the same as 0.1 cc recently we had some nurses debating this and the hospital got an answer from the manufacture that confirmed that units and 0.1cc are not the same.
  3. by   chris_at_lucas_RN
    meds are in ampules so no need to go threw a rubber stopper
    Doesn't this necessitate the use of a filter needle for drawing up and therefore the change of the needle for administration?

    Also, the TB vs insulin syringe issue was a question on a nursing exam when I was in school.... the instructors made quite a big deal out of it, as well they should.....
  4. by   adidas99
    [QUOTE=suzanne4]Silly question....how are you drawing up meds thru a thick rubber stopper with a blunt needle? They can't pierce the rubber. :uhoh21:
    QUOTE]

    Never have a prob using the blunt needle. Punctures the rubber top without problems.
  5. by   Achoo!
    alot of the stoppers are made of latex as well, so better safe than sorry. I always change needles.
  6. by   Todd SPN
    Whenever I give an IM, I always recall one of the first one I gave. I had to mix rocephine with lido so the needle went into vials x3 before I was ready to inject. The needle just bounced off the guys butt when I went to inject. Thankfully he was comatose.
  7. by   Dayray
    [QUOTE=chris_at_lucas]Doesn't this necessitate the use of a filter needle for drawing up and therefore the change of the needle for administration?
    QUOTE]


    Well yeah at least in my opinion: it should be drawn up using a filter needle and we did complain about this because all of our ampule drugs are given in 1 cc syringes and the needles don't come off. Administration countered us with some research that says that the needle is so small on a 1 cc that filter needles aren't necessary, not that I agree but they did at least rewrite the policy to say specifically that we don't have to use a filter needle.

    I'm sure what they used to make their decision was the cost of removable needles + filter needles -vs- potential cost of a lawsuit resulting from a fragment being stuck in a patients body. Being that the fragment would be very difficult to find and not that likely to cause a problem they chose the risk over the cost of better equipment. I still don't like the idea though.
  8. by   chris_at_lucas_RN
    Quote from Dayray
    Well yeah at least in my opinion: it should be drawn up using a filter needle and we did complain about this because all of our ampule drugs are given in 1 cc syringes and the needles don't come off. Administration countered us with some research that says that the needle is so small on a 1 cc that filter needles aren't necessary, not that I agree but they did at least rewrite the policy to say specifically that we don't have to use a filter needle.

    I'm sure what they used to make their decision was the cost of removable needles + filter needles -vs- potential cost of a lawsuit resulting from a fragment being stuck in a patients body. Being that the fragment would be very difficult to find and not that likely to cause a problem they chose the risk over the cost of better equipment. I still don't like the idea though.
    There is a reason filter needles were ever used, and it is because glass fragments can be extremely tiny. Glass does not break cleanly.

    Changing policy only keeps them from using it is a reason to fire you when the patient sues, and in fact it keeps them in the legal loop, liability-wise. I am amazed they had to be asked to do this--if the filter needle policy was in place, they had no business asking anyone to do it differently until they changed the policy!

    I'm glad to hear you don't like the idea!!! It sounds like a bad one!!! :imbar

    Maybe you can do your own research (I like to say, that's why God made google ). You could start with the companies that make and/or market the filter needles. I'm sure they have plenty of information they would provide for free.

    These injections aren't going IV or IM, right? (Right?) If they are going into subQ, and the patient gets some kind of localized inflammatory process, or bruising (from little tiny cuts in little tiny vessels), maybe that can be dealt with.

    As for cost cutting and liability, my understanding was that hospitals had gone to preloaded syringes for many meds (but maybe this is just IM's). Saves time, protects patient comfort, says what the med is right on the barrel (fewer errors).

    One wonders what the liability carriers' (insurance cmpanies') position would be on not using filter needles on injectable ampuled meds....

    The whole issue makes me think of the criterion for knowing if what one (and I mean the hospital, not you personally) was doing was right or probably wrong: would you want everyone to know (how) you were doing it?

    Thanks for your post. I didn't know there were still hospitals who used ampules, much less without filter needles....
  9. by   epiphany
    question 1: Don't we have to squirt the syringe after we put in a new needle to remove the air?

    question 2: If so, for drugs irritating to the skin, you cannot avoid a little droplet on the bevel even with a new needle, right? In that case, how does changing a needle help you prevent irritating drugs from touching the skin, as some of you say?

    Hope I'm not sounding stupid.
  10. by   sharon holcombe
    Thank you - and no you're not sounding stupid - what really is stupid is that our leaders (no matter what discipline) think that there has to be documented research on every question's answer and we can't just write a policy that demonstrates a little thought and common sense along with a little knowledge accumulated along the road of experience - and for that I hold lawyers and judges accountable for allowing the king to walk naked through the courtroom as if he has beautiful robes on that only the wisest can see - so no one admits their ignorance - but I digress Thank you again for your response
    Quote from epiphany
    question 1: Don't we have to squirt the syringe after we put in a new needle to remove the air?

    question 2: If so, for drugs irritating to the skin, you cannot avoid a little droplet on the bevel even with a new needle, right? In that case, how does changing a needle help you prevent irritating drugs from touching the skin, as some of you say?

    Hope I'm not sounding stupid.

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