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Filter needles...are they necessary?

Posted

Specializes in Pulmonary med/surg/telemetry. Has 1 1/2 years experience.

I'm about to graduate in 2 months and I know there are things that are different in the real world than "textbook." I see nurses on the floor do so many things differently than what I'm taught and lately I've been struggling with figuring out which things are okay to do a different way and which are just nurses taking unsafe shortcuts. One of my issues lately is the use of filter needles. I always use filter needles when administering meds from ampules. Nurses will kind of snicker and make comments about me using them because I'm a student. Do you use them? I was taught that shards of glass can be injected into the vein if the filter needles aren't used. Is this true or is this just in theory and the filter needles aren't actually necessary?

Also, if you have time...can you mention some things off the top of your head that really are okay to do differently than what is taught textbook.

Thanks.

canesdukegirl, BSN, RN

Specializes in Trauma Surgery, Nursing Management. Has 14 years experience.

ALWAYS use a filter needle. Why take the risk?

As far as I know...filter needles are relatively new, which begs the question, are they really necessary? In my opinion, if they stop me from injecting glass into just one person then sure, they are worth it. Just remember to switch the needle before you inject.

fsaav

Specializes in Pulmonary med/surg/telemetry. Has 1 1/2 years experience.

I thought the same thing, but once I realized that absolutely NO nurses on the floor that I was on use them I wanted to check. It's one thing for a few nurses here and there to take shortcuts but it really made me wonder when no one was doing it.

The filter needles are there for a reason. Whether you or anyone else uses them is your on prerogative...although I suspect there is probably a policy in place.

anonymous1919, LPN

Specializes in Geriatrics.

If others want to risk injecting glass into their patients... what ever. I wouldn't use anything but a filter needle first.

brownbook

Has 35 years experience.

Hi, had to laugh. About 6 weeks ago I posted the same question. I've been a nurse 28 years!!!!!

One responder mentioned an article in Journal of Advanced Nursing 2004, 48-(3); 266-270. Another had worked as a pharmacy tech and they always used filter needles. Some had never heard of filter needles, but everyone else said yes of course, always use them.

I asked my question because I am sometimes in OR's and access anesthesia carts for syringes, needles, etc., and they don't even stock filter needles on their carts????? Also I see co-workers with many years experience not using filter needles.

I love your second question. I will have to think about that one.

JB2007, ASN, RN

Specializes in LTC, Med-SURG,STICU. Has 5 years experience.

Always use a filter needle when drawing up meds from an ampules. Then change to a regular needle before giving the med. Do not ever take a shortcut that could compromise your pts safety. Let the other nurses laugh at least you are doing everything you can to ensure your pt safety. This small step takes maybe 2 seconds and is not much of a time saver anyway.

You might want to bring the situation up to the NM because there may be a need for education on an important safety isssue.

DCtraumarn

Specializes in Trauma, Burn, Crticial Care. Has 9 years experience.

Yes - always a filter needle when drawing from ampules. My doc's do as well....

Spacklehead, MSN, RN, NP

Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care. Has 14 years experience.

As far as I know...filter needles are relatively new, which begs the question, are they really necessary? In my opinion, if they stop me from injecting glass into just one person then sure, they are worth it. Just remember to switch the needle before you inject.

Not sure what you mean by "new," as I've been using them for at least 10 years. Yes, I agree, they are necessary for drawing up meds from ampules.

I would suggest using them. Be influenced by protocol ,policy and patient outcome, not shortcuts or snickering coworkers.

I'd say it depends on policy. Since the risk of injecting glass into a patient is about 1 in a billion, no one, not even the docs, uses them in the ER I work in. Occasionally we get a newbie who wants to use them, but what I've observed is the nurse who is over-the-top anal about some insignificant thing is lacking in the important skills such as EKG interpretation, pain management, assessment skills, etc. - there are many more important things to concentrate on. So in the big picture, NO, I don't think filter needles are necessary.

Let's put it this way, if you needed the medicine... would you prefer I use a filter needle or just skip it?

Perpetual Student

Specializes in PACU. Has 4+ years experience.

I like to use them regardless because they are less flimsy and 99% of the time I'm going to give the med IV anyway.

anononurse

Specializes in Geriatrics/Med-Surg/ED.

I have to agree, hone the skills you need - if you want to use filter needles, fine- but broaden your knowledge base to develop real skills: patient assessment, accurate EKG interpretation, critical thinking, prioritizing, good time management, etc. So many newer nurses are lacking in these areas. Focus on what's important, take extra courses if necessary, especially if you expect to have longevity in this field!

Asystole RN, BSN, RN

Specializes in Vascular Access, Infusion Therapy.

American Association of Critical Care Nurses

AUGUST 98 - VOLUME 18 - NUMBER 4

FILTER NEEDLES AND GLASS AMPULES

Q. Are special filter needles required when drawing up medication from a glass ampule? Are there hidden risks to patients, ie, sharp glass particles, if a filter needle is not used?

A. Fred L Meister, PharmD, replies:

Bacterial contamination has always been the major concern associated with the intravenous administration of medications and is a well-known cause of morbidity and mortality. Additional risk factors, however, have been identified and must also be considered.

The potential risks associated with administration of medications supplied in glass ampules is much greater than realized by most practitioners. Opening a glass ampule produces a shower of glass particles, many of which enter the ampule and contaminate the contents. Some of the particles have been shown to carry bacteria, though the significance of this has not been determined.

The number of glass particles found in opened ampules varies, but most reports indicate approximately 100 particles, ranging in size from 10 to 1,000 µm, per 10-mL ampule. The particle count increases as the size of the ampule increases (ie, a 20-mL ampule will contain more glass particles than a 10-mL ampule). When the content of a 10-mL ampule is aspirated through an 18-gauge, 1.5-inch needle, the particle count is reduced by approximately one third (ie, approximately 65 particles remain in the aspirate), and the maximum particle size is reduced to less than 400 µm.

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.

The effective removal of glass particles from an opened ampule can be accomplished by aspirating through a 19-gauge, 5-µm filter needle. Using this method decreases the average total number of particles in the aspirate to approximately ±1, and the particle size to less than 200 µm. Using a 0.22-µm in-line filter offers little or no additional benefit, and is more costly and labor intensive--once the ampule content is aspirated into a syringe, the filter needle must be replaced with a standard needle prior to transferring or administering the medication.

Based on the available information, a filter needle is recommended when aspirating a medication from a glass ampule.

References

  1. Turco S, Davis NM. Glass particles in intravenous injections. N Engl J Med. 1972;287:1204-1205.
  2. Carbone-Traber KB, Shanks CA. Glass particle contamination in single-dose ampules. Anesth Analg. 1986;65:1361-1363.
  3. Waller DG, George CF. Ampules, infusions and filters. Br Med J. 1986;292:714-715.
  4. Kempen PM, Sulkowski E, Sawyer RA. Glass ampules and associated hazards. Crit Care Med. 1989;17(8):812-813.
  5. Sabon RL, Cheng EY, Stommel KA, Hennen CR. Glass particle contamination: influence of aspiration methods and ampule types. Anesthesiology. 1989;70(5):59-62.
  6. Falchuk KH, Peterson L, McNeil BJ. Microparticulate-induced phlebitis: its prevention by in-line filtration. N Engl J Med. 1985;312:78-82.

Fred L. Meister is a clinical pharmacologist at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif, and an assistant clinical professor at the University of California, San Francisco.

OttawaRPN

Specializes in acute care med/surg, LTC, orthopedics. Has 5 years experience.

...can you mention some things off the top of your head that really are okay to do differently than what is taught textbook.

How much time do you have?

brownbook

Has 35 years experience.

Asystole, thanks so much. That says it all.

In an emergency situation many routine standards of practice are not adhered to. In ER's it may sometimes be acceptable to not use a filter needle. But it should not be a routine standard of practice in a non-emergency situation.

I re-took PALS a week ago, it was mentioned, with a great roll of eyes, that if a needle is used to puncture the rubber/plastic stopper on a pre-filled epinephrine syringe a filter needle should be used!!!!!! Now that is crazy making.