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.
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!
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
Turco S, Davis NM. Glass particles in intravenous injections. N Engl J Med. 1972;287:1204-1205.
Carbone-Traber KB, Shanks CA. Glass particle contamination in single-dose ampules. Anesth Analg. 1986;65:1361-1363.
Waller DG, George CF. Ampules, infusions and filters. Br Med J. 1986;292:714-715.
Kempen PM, Sulkowski E, Sawyer RA. Glass ampules and associated hazards. Crit Care Med. 1989;17(8):812-813.
Sabon RL, Cheng EY, Stommel KA, Hennen CR. Glass particle contamination: influence of aspiration methods and ampule types. Anesthesiology. 1989;70(5):59-62.
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.
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.
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.
For me, using a filter needle is second nature to me and not even something I think about - just like when I pull IV tubing out of the packaging I automatically, mindlessly close the clamp. These are not insignificant tasks - just something I automatically do without thinking because I learned correctly from the very beginning. It certainly does not take my time or attention away from other "important" skills.
For me, using a filter needle is second nature to me and not even something I think about - just like when I pull IV tubing out of the packaging I automatically, mindlessly close the clamp. These are not insignificant tasks - just something I automatically do without thinking because I learned correctly from the very beginning. It certainly does not take my time or attention away from other "important" skills.
Well said. I worked somewhere that did not care for my hypervigilence. They frequently tried to put me down in this way. They tried to claim that I focused on some things which made me lack in other areas. Truth is...I'm just anal in general, and prefer to do things the right way. I think in nursing it's important to realize we will constantly learn new things- and need to adapt to the best way possible for our patients.
Buck eye
7 Posts
Let's put it this way, if you needed the medicine... would you prefer I use a filter needle or just skip it?