Amiodarone IV: needs an inline filter??

Specialties PACU

Published

I'm still orienting in PACU and it ain't easy when your preceptor doesn't think you're good enough to be there becaus the highest critical care experience I have is 2 years in IMC.

Anyways....

One night, we were doing a CABG, and my preceptor asked me if I've hung amiodarone before and I said yes so she gave it to me. I looked at the bag and there was a blue thing attached to it. I asked her what it was. She was shocked and said "Obviously, you haven't hung amiodarone before. This is a filter and Amiodarone needs an inline filter". I was dumb founded.

In the other facility I worked at, we never used an inline filter for amiodarone. Just now, I called their pharmacy and he verified that yes, we do have a protocol for amiodarone iv but we never had to use an inline filter.

However, on the drug books that I've read, it does say to use an inline filter. I'm not about to debate this case to my preceptor but I sure would like to know if it was okay for that other facility to continue hanging amiodarone without an inline filter or not. Or, if this new facility I'm working at is just stuck on the olden' days.

What do you think???

~taski12

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Specializes in Critical Care.

Yes, requires an in-line filter.

It is NOT OK for the other place to not use a filter. Legally speaking, should harm result, all the definitions of a valid tort exist in not using a filter: you had an obligation, you failed the obligation, and harm resulted.

A prudent nurse, on the witness stand, would testify to this. I would.

Read the packet insert. Your pharmacy should be able to send you one.

~faith,

Timothy.

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I'm new in the ICU, too...so, what drips need a filter? Apparently Amiodarone, lipids, what else? There's another one, but can't think of the name right now.

Are you still using a filter for protonix? My old hospital we were giving it IV push in 10ml NS or sterile water, new facility runs it in a dedicated line, no filter over 15 minutes.

I know what you're saying about the preceptor...mine have all been great, it's the Intensivist. Everytime I open my mouth I seem to spurt out the stupidest things. Fortunately, he's very nice, but I'm afraid that if I don't stop soon, he's never going to trust me! It's so hard to be new, isn't it?

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Specializes in ER, ICU, Infusion, peds, informatics.
i'm new in the icu, too...so, what drips need a filter? apparently amiodarone, lipids, what else? there's another one, but can't think of the name right now.

are you still using a filter for protonix? my old hospital we were giving it iv push in 10ml ns or sterile water, new facility runs it in a dedicated line, no filter over 15 minutes.

i know what you're saying about the preceptor...mine have all been great, it's the intensivist. everytime i open my mouth i seem to spurt out the stupidest things. fortunately, he's very nice, but i'm afraid that if i don't stop soon, he's never going to trust me! it's so hard to be new, isn't it?

dilantin requires a filter. it has a tendency to crystalize once mixed, and infusing it without a filter is a big no-no. however, i have worked in facilities where it wasn't sent from pharmacy with a filter. solution? i pushed it (agonizingly slowly) through a *new* filter needle.

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Specializes in Cardiac Telemetry/PCU, SNF.

I've always run Amio with a filter, just one of those givens. As for others, I know Dilantin (as mentioned above), and if memory serves this morning, Mannitol requires a filter.

Just my $.0.02,

Tom

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Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

You should have replied back that Amiodarone should not be in a BAG, it should be in a bottle of D5W if it is not just a bolus.

Nurse1966: Dilantin needs a filter.

Swtooth

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Specializes in ICU.

Filter is used for both Amiodarone and Dilantin. Usually the filter size is 0.22 micron. Dilantin is mixed in Normal Saline only.

Lipids are never filtered and if your facility uses filters for their TPN's then the Lipids go below the filter or the port closest to the patient.

If in doubt, call your Pharmacy or use your drug books or Micromedex (or the likes), because Zashagalka is right about being a prudent nurse.

Also, I do not understand why some nurses readily forget their past life as a newbie.Good luck!

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Specializes in ICU.

Amiodarone gtts can be in bags now. The pharmacy at my hospital routinely mixes it that way now.

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I have not ever pushed Amiodarone or hung it ONCE in my 6 years in PACU. It never came up or was ordered.

I don't really like that your preceptor is so snappy. What is the problem? Does she not like precepting or does she have a gripe about you personally. I think you need a preceptor who appreciates that PACU is a specialty and even a seasoned IC"U nurse would need orientation.

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Amio doesn't require a filter always...it depends on the concentration. Amio that is mixed 900mg/500ml does not require filter. I checked with our pharmacy today and was told that filters are only required when it's not mixed 900mg/500ml. Any ideas why?

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You've got a point there. I mean, on concentration wise. We use 450mg/250ml. That's probably why we use filter.

On my preceptor's attitude, I don't know. I guess it's because she's a product of the era "spare the rod spoil the child" that she's treating me the same way too. My in-law is a very positive person and she shares my in sight that I am in a very emotional and psychological draining experience

Thanks for the dilantin, tip. I'll look it up. Although, I've never seen anyone use a filter when they administered it.

Amio doesn't require a filter always...it depends on the concentration. Amio that is mixed 900mg/500ml does not require filter. I checked with our pharmacy today and was told that filters are only required when it's not mixed 900mg/500ml. Any ideas why?
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Specializes in ER, ICU, Infusion, peds, informatics.
you've got a point there. i mean, on concentration wise. we use 450mg/250ml. that's probably why we use filter.

on my preceptor's attitude, i don't know. i guess it's because she's a product of the era "spare the rod spoil the child" that she's treating me the same way too. my in-law is a very positive person and she shares my in sight that i am in a very emotional and psychological draining experience

thanks for the dilantin, tip. i'll look it up. although, i've never seen anyone use a filter when they administered it.

the more concentrated a drip is, the more likely it is to crystalize (in general; think about chemistry, reaction rates, and concentrations. the more concentrated the solution is, the more likely molecules will run in to each other).

however, 900mg/500 cc is the same concentration as 450mg/250 cc (just a different volume. concentration is the same -- both 1.8mg/ml.)

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