Filter needles for glass vials?

[jrsmrs]

Does your facility have/use filter needles for meds in glass vials? We were taught to use them in school, but I've never actually seen them on any floor I've been on, so I just do without.

[Love_2_Learn]

I have been doing some research on this subject and found this website to be very enlightening!!!

http://findarticles.com/p/articles/mi_m0FSS/is_5_15/ai_n17215448/

Wonderful article! Thanks for sharing! I hope subee gets a chance to read it especially since anesthesia specialists recognized the problem first.

[crb613, BSN, RN]

We have'em & I use'em!

[jrsmrs]

Sorry, yes, I did mean amps, not vials. And yes, I have asked on a few different floors if they had filter needles, but they never do.

As far as changing needles, if my needle has pierced anything (ie, the rubber stopper of a vial), I do change to a new one before injection.

[IVRUS, BSN, RN]

In 30 years of giving anesthesia, I've probably opened about 20,000 ampules without a filter..as does every other anesthesia practitioner and have never heard of or read about glass shards being identified as problematic in real life. Oh good grief, I hope the committees that write the cook books to micromanage every aspect of our practice never hear about this one!:)

Well, not 'hearing about it' doesn't necessarily equate to best practice. When a glass ampule is broken, thousands of glass shards fall into the medication. If that medication is given intraveneously, think of how problematic that is to the smooth endothetial surface of the tunica intima in the blood vessel. Okay, so not giving it IV? Now all those glass shards are left in my butt However... The main aspect is where are those glass fragments ending up... well, prior to many, many nurses using them in todays health care.. on autopsy, the lungs were filled with granulomas as the body tried "walling" off the glass... How's that affecting gas exchange...Hmmm.

[xtxrn, ASN, RN]

Sorry, yes, I did mean amps, not vials. And yes, I have asked on a few different floors if they had filter needles, but they never do.

As far as changing needles, if my needle has pierced anything (ie, the rubber stopper of a vial), I do change to a new one before injection.

When possible, I'd change the needle before giving IM/SQ injections, just so the residual med wasn't on the needle, possibly causing pain. I'd draw up a bit extra when I could, and then "re-prime" the new needle (with its dead space), so the full dose was given. With the tiny gauge of most insulin syringes now, they really don't hurt, even after being in the vial... The Lantus burns at new sites, so not much to do about that. It tends to get better if the area has been 'shot' before. (insulin is from experience, not just from giving tons of them- needles come in 31g, which are a breeze. :))

[rita359]

Correct me if I'm wrong, but I thought using filter needles when drawing meds from ampules became a standard of care a long time ago. Filter needles are on our csr pysys or available from central supply. Find out where they are in your institution and USE them.

[subee, MSN, CRNA]

Well, not 'hearing about it' doesn't necessarily equate to best practice. When a glass ampule is broken, thousands of glass shards fall into the medication. If that medication is given intraveneously, think of how problematic that is to the smooth endothetial surface of the tunica intima in the blood vessel. Okay, so not giving it IV? Now all those glass shards are left in my butt However... The main aspect is where are those glass fragments ending up... well, prior to many, many nurses using them in todays health care.. on autopsy, the lungs were filled with granulomas as the body tried "walling" off the glass... How's that affecting gas exchange...Hmmm.

Nobody monitors gas exchange like anesthesia. We monitor oxygenation and ventilationi in real time. Since millions of ampules are opened and administered daily, surely there would be thousands of reports in the anesthesia literature. We are using 1cc., 2cc. and 5cc. amps so maybe size does matter.

[~Mi Vida Loca~RN, ASN, RN]

Yes we have them and use them. I very rarely have a medication that needs one. I think I have done it twice since starting.

[MunoRN, RN]

In 30 years of giving anesthesia, I've probably opened about 20,000 ampules without a filter..as does every other anesthesia practitioner and have never heard of or read about glass shards being identified as problematic in real life. Oh good grief, I hope the committees that write the cook books to micromanage every aspect of our practice never hear about this one!:)

What's common practice in anesthesia hardly defines good practice. A survey by AANA found that 1 in about 30 Nurse Anesthetists said they use the same needle and or syringe on multiple patients, a practice that has resulted in multiple cases of hepatitis and other blood-borne disease transmission in recent years. And that's how many of those surveyed openly admitted to this practice, how many more at least knew enough to say they didn't do it?

Nobody monitors gas exchange like anesthesia. We monitor oxygenation and ventilationi in real time. Since millions of ampules are opened and administered daily, surely there would be thousands of reports in the anesthesia literature. We are using 1cc., 2cc. and 5cc. amps so maybe size does matter.

I'm not sure how you think your monitoring will explicitly show glass shards, do you have a "glass shard indicator light" on your equipment. Otherwise, you're unlikely to differentiate any immediate effects of glass shards from normal fluctuations in respiratory status, particularly since the effects are more along the lines of chronic inflammation, which takes days begin developing.

Ampoule size does matter, but it doesn't mean your not injecting glass shards with small ampoules; one study showed that 22% of syringes drawn up from 1ml ampoules contained glass shards and 39-56% drawn up from 2ml vials contained glass shards.

This article from AACN sums up what we know about the effects:

"The potential risks associated with intravenous administration of glass particles are based on animal studies, though similar risks would apply equally to humans. It has been shown that glass particles cause inflammatory reactions (eg, phlebitis) and granuloma formation in pulmonary, hepatic, splenic, renal, and intestinal tissue. This represents a significant risk of an adverse patient outcome."

Thanks to filter needles, you have the choice to not inject glass shards into a patient, why would you not take advantage of that option other than laziness and a lack of respect for your patient's basic right not to be injected with glass shards. Would you feel comfortable telling your patients that you could filter out the glass particles if you wanted to but you chose not to?

[opossum]

Small hint of advice: When breaking the neck of the ampule, use the cover of the alcohol swab so you don't cut yourself.

I've twice used the alcohol wrapper to open an ampule and have still managed to cut the same finger both times, on either side! The first one required a pressure dressing

[MunoRN, RN]

Nobody monitors gas exchange like anesthesia. We monitor oxygenation and ventilationi in real time. Since millions of ampules are opened and administered daily, surely there would be thousands of reports in the anesthesia literature. We are using 1cc., 2cc. and 5cc. amps so maybe size does matter.

http://classic.aacn.org/aacn/practice.nsf/a40dd285cb9efd8e8825669e00031e21/69d2c30ba9fa866c88256754006d7cde?OpenDocument

http://findarticles.com/p/articles/mi_m0FSS/is_5_15/ai_n17215448/

[OgopogoLPN, LPN, RN]

I always use a filter needle when drawing up from a glass ampule. I use a regular blunt fill needle when drawing from a vial, then change to correct gauge and lenth needle.