Using Ampules w/o filter needles

[ilovenursing2009]

I work for a company that does not supply filter needles to be used with the epi ampule in the emergency kit.

Is this ok?

In nursing school I was told to never use ampules unless I had a filter needle. What do you think?

[geeimjo]

Hello Everyone - I am glad this topic has generated so much debate - makes me feel less lonely in my quest for discovering what best practice constitutes with regards to use of THE FILTERED NEEDLE...

I started working in a hospital that supplies filtered needles, and we were taught to use them if drawing up meds from glass ampules. Then I moved, and the hospital I worked at didn't supply them, even though we were told in our orientation that we were expected to use them... First I asked how to get them ordered - I asked the Charge Nurse, the clinical educator, the clinician, the unit clerk (who I was told did the actual ordering), the supply room stock-person, the manager... I also looked up whether or not using the filtered needles was best practice, or just theory-based practice. I found the site with the article that suggests that glass particulate may cause pulmonary thrombi and microemboli, etc (http://findarticles.com/p/articles/mi_m0FSS/is_5_15/ai_n17215448/ quoted on one of the earlier posts). I also found this study suggesting that there is no difference:

http://handle.dtic.mil/100.2/ADA284401

http://en.scientificcommons.org/19889561 (this site links to the pdf file above, in case it is not available via the posted link here)

Look it up, see what you think. I hope to find more on this. Am busy taking my critical care training right now, so not much time for my own research, but will continue to follow this thread. Take care! :[anb]:

[RXtech]

I have worked in hospital pharmacy for 15 years and was taught to and always use a filter needle for glass amps. Always!!!! And yes, you have to pull the med up in the filter needle and then switch needles. I have seen pharmacists throw out IV bags when a tech has forgotten to use a filter needle.

[DeepFriedRN]

I recall being told by a hospital pharmacist that the glass particulate can accumulate in the liver. I was taught to always use filter needles, but have met tons of nurses who have never used or heard of 'em. It's not a regional thing, either, because I went to one school in town and was taught to always use them, and work with a nurse who went to the other school in town and never heard of them.

[geeimjo]

It is clear we are told to use the filtered needles in some hospitals (and given varied reasons for doing so) and in others, nurses (and other HC workers) haven't even heard of them. The question isn't whether or not we've been told to use them, or their reasons for doing so. The question is, what reputable evidence is out there, that shows that drawing up meds from glass ampules without filtered needles has resulted in any of the damages feared to be caused by this practice. When I phoned the ICU for a filtered needle, they didn't have them either. I finally had them send me a few from PAR... If it was really so dangerous, wouldn't we have discovered this by now? Then again, a few people died before we found out about handwashing, didn't we??? Who'd 'a' guessed?

Anyone find any more studies out there? I am going to explore this on the university's database when I get a chance, rather than just on the www.

[cjcsoon2bnp, MSN, RN, NP]

I know that my facility has filtered needled available for use. In nursing school I was taught to draw up the med from the ampule with the filtered need and then removed the filtered needle (along with the micro-glass particles in the filter needle) and add a new needle if necessary (depending if its an IM med or getting injected into the IV bag or if its going directly into the IV line.) I was taught that this is evidence based practice, I wouldn't ever quit my job if we didn't have them but I would make an attempt to get them ordered or at least let management know to CMA.

!Chris

[chenoaspirit, ASN, RN]

Ive seen docs draw up meds from an ampule without using a filter needle, even though one is provided in the kit he opened. I always use a filter needle. Think about it...when you break glass, there is a good chance of small particles entering the vial. Then when you draw up the med, if the particles are small enough to enter the needle, then you re injecting directly into a vein. Whether the chance is 1/100000 or 1/10, Im not one to risk it. If it were me, I would refuse to have anything injected into me from a vial that wasnt drawn up with a filter needle. I was taught to use one and I will continue to use one.

[Cardiolyte]

always use a filter.....

[talaxandra]

Apart from on this site I've never heart of using a filter needle for routine drawing up, though we do use them when making up iron infusions or drawing up some clotting agents. I've done a very informal survey of my colleagues, none of whom have heard of them and who've worked at hospitals across Victoiria, Queenslad, South Austalia, Tasmania and the Northern Territory In other words, most of the country). I wonder if we have an significant but undetected incidence of bacterial infection and liver damage caused by microscopic glass shards.

[Lucky0220]

The first time I had to use an ampule, I went to look for a filter needle. We did not have any. As I asked a few of the nurses who had been on that floor for a while, they stated that they just don't have any, so they don't use them. Also true, that fewer and fewer meds are being packaged in ampules. I called our pharmacy and they had filter needles and brought some up to our department. So you might just want to check with your facility's pharmacy, because they told me they use them all the time when mixing up meds, and probably could help procure some for your floor. Just a thought!!

[drlisa]

I'm a doc and don't give injections that much but also was taught to use filter needles. Also some package inserts for these meds provided in ampules specify the use of filter needles. I applaud those nurses who are willing to initiate a discussion with management about this! If you do a pubmed search you will find studies on the potential hazards- especially for intravenous use (here is an example http://www.ncbi.nlm.nih.gov/pubmed/2719321). Also the APIC (Association for Professionals in Infection Control) in their position paper, Safe Injection, Infusion, and Medication Vial Practices in Healthcare, recommends use of filter needles (pg 3).

Hope this helps

[NewFNPinPA]

That source is from 1989 though, there has to be something better/ more definitive.

[talaxandra]

Maybe you didn't click on some of the links previously posted.

It does seem as though there are two camps and little concensus. In the "glass shards cause morbidity" camp there's this from 2006 (though most of the research cited to support risk was published between 1960 and 1977):

Prudent practicing nurses should be aware that glass contamination is a real hazard. Best practice includes use of filter needles when withdrawing medications from glass ampules.

And then there's this, also from 2006:

An investigation was undertaken to determine if there is a decrease in the number of glass particles aspirated from medications contained in glass ampules using filtered versus non-filtered needles of varying gauge... no significant difference existed in the number of glass particles counted following aspiration of medications from glass ampules using filtered needles compared to non-filtered needles, or when comparing non-filtered needles of varying sizes

As I wrote two years ago, when this thread was shiny and new:

As the use of filter needles is clearly not universal, one would expect to see a lower incidence of these kinds of complications in wards and hospitals that routinely use filter needles - "pulmonary thrombi and microemboli, infusion phlebitis, end-organ granuloma, and inflammation" as well as systemic infection from the bacteria-laden glass fragments unwittingly injected. I only had a brief search but couldn't find any in vivo research, only projecions and possibilities. I'm not saying the risk's not real, but figures on actual incidence would be useful. Oh, and wouldn't there also be a marked difference in injection site complication rates between filter and non-filter sites? [typos corrected from original]

When the Canadian Agency for Drugs and Technologies in Health asked that question last year, they found insufficient recent (