are filter needles necessary?

[brownbook]

I always use filter needles for drugs drawn from ampules. I notice many intelligent respected co-workers, including anesthesiologists, do not? The drug (I'm talking fentanyl here) is given via the IV access port, the needle is removed and the syringe screwed onto the access port. Does that somehow make filter needles not necessary? Do the screw on type access ports act as a filter?

[st3mueller]

This is an old article but it is research and not opinion or tradition:

Glass contamination in parenterally administered ... [J Adv Nurs. 2004] - PubMed - NCBI

The larger bore the needle, the more glass particles noted. I was interested in this question due to the now exorbitant cost of epipens coupled with the new recommendation that users carry two pens as opposed to one pen (even though less than 20% of carriers ever need a secondary dose prior to arriving in the ED). For school aged children who keep one pen at home and one in the school nurse clinic, the costs can reach $600 to $1000 per school year with or without insurance. Rather than carry epipens, I am considering having the parent ask their physician for ampule prescriptions with tuberculin syringes with small bore needles which costs less than $10, provides multiple dose per ampule if needed and is cheaply replaced if lost, stolen or broken. The small bore needles on a tuberculin syringe would be highly unlikely to pick up a glass particle and, even if this occurred, the IM injection of the particle is low risk.

[iluvivt, BSN, RN]

USP Chapter 797 list all the recommdations and this too may help:

Safer Injection Practices: Filter Needle Use with Glass Ampoules

There are time you also want to use a filter needle is when you are drawing up from a vial that has a latex stopper and the patient has a latex allergy. A few drugs also come with a filter needle or straw provided to either use to draw up or add to a mini-bag. The OP who stated the the shards end up in your lungs is right one. On autopsy they often find a dumping ground of debris on many a patient who has been hospitalized for any length of time that has not received the best of care!

[Lev, MSN, RN, NP]

The only time I don't use filter needles is with IV ativan, which is very viscous and hard to draw up with filter needles.

[xsarahx]

In the last place I worked as a student nurse, modazolam and fentanyl was drawn up using a green needle on a daily basics and was given by the consultant to the patient IV?? Is the incorrect practice? Could tiny glass shards kill a patient ?

I used to wonder about that but never questioned their practice as I was a student. I have never seen or been told about filter needles until I moved to Aus.

[NurseStorm, BSN, RN]

I know this is old, but I read it all before realizing, and see someone has brought it back so felt the need to comment on practice in Canada as I saw a few people saying they never used them in Canada. I have been nursing for 3 years and a student for 4 years before that and we have used filtered needles here in Eastern Canada throughout that entire time. Are there people who don't use them? Probably. But we stock them, and I have seen others frequently using them and I always do myself for glass ampules.

[xsarahx]

Every needle should have inbuilt filters for safety! And cannulas should have inbuilt filters. I am thinking maybe the green ones used on my last placement possibly had filters in them..

Like if patients were dying from glass shards . I think it would be a universal policy used everywhere .

But clearly there are people who never heard of them ... Would tiny glass shards be detrimental ?

[IVRUS, BSN, RN]

Yes the glass shards are detrimental! Think of those pieces of glass going into the IV catheter and scraping the inner lumen of the vein (Tunica Intima) and the process of phlebitis and thrombus formation which it starts. Then, as it travels along, where does it get trapped? Usually the small capillaries in the lungs, which will clog those capillaries, and interfer with O2/CO2 gas exchange. It is bad enough that nurses aren't filtering when drawing from an ampule and now all that glass is in my butt muscle... Think of how damaging it is when given IV.