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?

[PetiteOpRN]

Thanks for the info on filter needles and the studies showing the evidence. Now I'm curious- why do we still use ampules? What is the benefit over a vial or carpujet?

I can only speak to my specialty. There are some instances in the OR where an ampule is actually much more convenient than any other form for a few different reasons.

1. Amount. Sometimes all I need is 0.3 or 0.5 ml of Epi or 3ml Neo/Poly. It makes sense to supply these drugs in very small quantities.

2. Administration. I don't usually inject these meds, I mix them or pour them onto the field. When meds are in vials, many RNs pour from the vial, technically the correct thing to do is withdraw and squirt. Since that's really the only way to get meds from an ampule, everyone has to do it correctly.

3. Abuse. Yeah, I know ampules are not addict-proof but when narcotics are available in very small quantities, we don't have to waste as much. It's also usually pretty apparent when the ampules have been tampered with.

[RescueNinja]

I've worked in Canada for nearly 25 years and have never used a filtered needle.

Never heard of them until Allnurses.

I've only been around for my 4 years of nsg school, but I have always seen them in stock every single place I've been and have only seen ONE nurse use them ONE time and that was at CHEO for an infant

[XingtheBBB, BSN, RN]

I can only speak to my specialty. There are some instances in the OR where an ampule is actually much more convenient than any other form for a few different reasons.

1. Amount. Sometimes all I need is 0.3 or 0.5 ml of Epi or 3ml Neo/Poly. It makes sense to supply these drugs in very small quantities.

2. Administration. I don't usually inject these meds, I mix them or pour them onto the field. When meds are in vials, many RNs pour from the vial, technically the correct thing to do is withdraw and squirt. Since that's really the only way to get meds from an ampule, everyone has to do it correctly.

3. Abuse. Yeah, I know ampules are not addict-proof but when narcotics are available in very small quantities, we don't have to waste as much. It's also usually pretty apparent when the ampules have been tampered with.

All would be good reasons for carpujects, too. Do you do eye rooms? I imagine epi in carpujects would be nice with the rapid turnover and barrage of meds we give in the first 5 minutes of a pt hitting the room... and oh yeah, use your third arm to add epi to the BSS! Also, when you have to keep all used vials available in the room for reference until the case is over, I'd rather have a cartridge than a broken ampoule!

Cost is the issue, I imagine, in most cases. I thought there was something about a handful of meds (and NOT the ones that actually hit the floor in ampoules) being unstable when exposed to the porous polymers in stoppers? A quick search engine showed nothing helpful? ....Corlee?...

Given the choice of an ampoule or a vial/cartridge in a severely latex allergic individual... I'll grab the ampoule, thanks.

[Scrubby]

I've never heard of them either. Where I work we regularly draw up urograffin, heparin and papaverine without filter needles. I might do some research on this and bring it to the attention of my CNC.

[GHGoonette, BSN, RN]

I've worked in Canada for nearly 25 years and have never used a filtered needle.

Never heard of them until Allnurses.

In 27 years nursing in South Africa, I have never heard of them-neither in State nor Private hospitals. I googled South African pages last night after reading this thread, and guess what I found? FUEL filters, KNITTING needles, FUEL injection...! Suspend your disbelief guys, these things really have not found their way to South Africa! On the world wide pages I did find descriptions and suppliers, and I know which companies are agents for BD and Kendall, so I can find out if they've ever heard of filter needles.

[clemmm78, RN]

I've worked in Canada for nearly 25 years and have never used a filtered needle.

Never heard of them until Allnurses.

Same here. Been a nurse since the early 80s, never heard of filter needles until here.

[Corlee]

The biggest reason that ampules are used is that it is cheaper for the pharmacy department to purchase an ampule over a vial, as well as for Hospira to manufacturer the drugs in teh amps as well.

[canoehead, BSN, RN]

I used them all the time in the US, but not at all in Canada.

[RXtech]

Another pharmacy tech turned nursing student here. We always use filter needles for glass ampules. I had never heard of NOT using filter needles until going into nursing. I was discussing this with some of the pharmacists I work with the other day, and they couldn't believe it. My boss was so disturbed he started talking about having an inservice about it.

Thanks for the info on filter needles and the studies showing the evidence. Now I'm curious- why do we still use ampules? What is the benefit over a vial or carpujet?

Some drugs are affected by the rubber, latex, or plastic that vials are made with. But I imagine cost is a factor, too.

[Corlee]

Another pharmacy tech turned nursing student here. We always use filter needles for glass ampules. I had never heard of NOT using filter needles until going into nursing. I was discussing this with some of the pharmacists I work with the other day, and they couldn't believe it. My boss was so disturbed he started talking about having an inservice about it.

Some drugs are affected by the rubber, latex, or plastic that vials are made with. But I imagine cost is a factor, too.

My boss too!! Any of the pharmacists i have talked to are like, WHAT??? lol. Glad to see another pharm tech/nursing student in the mix!!

[SaraO'Hara]

Another nurse here who's never heard of NOT using the filter needle.

[IVRUS, BSN, RN]

I always use filter needles when drawing from an ampule. I'm doubting that anyone was ever actually harmed from being injected with tiny glass shards. It's probably more a theoretical risk than anything else. However, since filter needles are readily available, it's an easily preventable risk. So I use them. We used to have labels on ampules reminding us to use filter needles, but those have recently disappeared.

Blondy,

Harm has come from NOT using filter needles. Think of what the glass shards do to the smooth endothelial layer of the vein.. But that's not the only problem. Before nurses started using the filter needles or filter straws diligently, patients who died would be noted to have several granulomas in their lungs where the glass was seen by the body as a foreign substance and it made attempts to wall it off. Think of what that does to the gas exchange!?