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- Aug 26, '11 by subeeQuote from IVRUSNobody 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.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.
- Aug 26, '11 by ~Mi Vida Loca~RNYes we have them and use them. I very rarely have a medication that needs one. I think I have done it twice since starting.
- Aug 26, '11 by MunoRNQuote from subeeWhat'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?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!
Quote from subeeI'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.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.
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?
- Sep 10, '11 by opossumQuote from Butterfly2625I'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 dressingSmall hint of advice: When breaking the neck of the ampule, use the cover of the alcohol swab so you don't cut yourself.
- Sep 13, '11 by MunoRNQuote from subeehttp://classic.aacn.org/aacn/practic...e?OpenDocumentNobody 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.
- Sep 13, '11 by OgopogoLPNI 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.
- Sep 13, '11 by PetiteOpRNI always do off the field (epi, neo/poly).
We don't have sterile filter needles, so I can't use filters on the field (ie to draw up methyl methacrylate).
- Mar 16 by Marina9779Yes to filter needles & ampoules
The Canadian Potter & Perry also mentions that you can use a filter needle when drawing up meds from vials, to avoid pieces of rubber getting into solution. Thoughts about this? I haven't researched this one yet.
- Mar 16 by MN-NurseWe have filter needles. Haven't seen a glass vial in over a year.
- Mar 17 by Racer15I would never draw up a med from an ampule without a filter needle, you never know when a tiny bit of glass might break off into the medication.. And yes, when doing an IM injection, I always use one needle to draw up the drug, and a separate one to administer the injections. And I sure hope the nurses giving me shots do the same!