Filter needles...are they necessary?

[fsaav]

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.

[Medic/Nurse, BSN, RN]

Since you have to use a NEEDLE of some sort to draw up the med - what is the big deal in just using a filtered one.

And since you need to change this needle to one suitable for injecting or remove it entirely to access needle-less systems - I just fail to see an issue. If available - use them.

As for the PALS class that noted changing needles when drawing from rubbered pre-filleds, well - same point. What system are you using for administration?? PALS resus is an IV sport - and most needle-less systems demand that the needle be removed.

Make your practice the safest for the patient and simple for you. WIN-WIN.

Practice SAFE!

:angel:

[HamsterRN, ADN, RN]

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.

The evidence suggests that the chances are closer to 1 in 1, not 1 in a billion. There are more important things to concentrate on than filter needles, hand washing, aseptic technique, documenting allergies, etc, but they are still important, and I wouldn't say that a Dr is always the best example of good practice habits. If your Docs aren't using them then you need to stop them and educate them. Personally, I'd prefer to have bacteria injected to me than glass, at least the bacteria will probably go away at some point, the glass may be permanent, and even if it never causes any harm it's more commitment than I like.

It is possible to be so detail oriented that a nurse misses the forest for the trees, but using filter needles, or non-coring needles with a rubber stopper, isn't that distracting from the big picture, it's just not being lazy and unnecessarily reckless.

The Checklist Manifesto explains the issue of our failure to do the basics better than I can; but basically it doesn't matter how good we are at the complicated stuff if we're harming patients by missing the basic stuff.

[rn/writer, RN]

i've been using filter needles since the early 90's, and they weren't new back then.

is there particulate matter in ampules?

particulate contamination of small-volume parenteral products has been considered since single-dose ampules were developed nearly 30 years ago for ease of administration and accuracy.1 in 1972, turco and davis first noted that glass fragments greater than 5µm could be aspirated from open ampules of furosemide.4 today, the fact that snap-opening of ampules leads to contamination of contents with glass fragments is well known.1-4 numerous studies confirm particulate contamination of ampules upon opening, implicate a variety of side-effects from injecting nonfiltered ampule medication into patients3-7 and offer suggestions for changes in practice.

here is the link to the article containing the paragraph above:

practice

it's the fourth article on the page.

according to these folks, filter needles should be used.

[OgopogoLPN, LPN, RN]

I always use one when drawing up from an ampule.

[royhanosn]

I never used filtered needles, adds cost to the system, and the meds are sterile when you pull them out of the bottle.

as for the way others do their nursing..you have text book nursing. NOW its time to do real world nursing. Your classes were protected classes. your a rookie!

If they question what your doing, ask them how they do it! You will LEARN!

[AndyLyn]

I don't understand why you WOULDN'T use a filter needed. You have to draw it out with a needle, it's just as easy to grab a filter needle out as a standard one. Not using one is just being stubborn. It's saying that just cuz I can't SEE the glass, they aren't there... hmmmm... I wonder if those germies are real, too?

PS. Using the docs as a point of reference can be a slippery slope. We need to use our best NURSING judgement, and that means protecting my patients from harm the best way I can.

[muesli]

I use filtered needles with ampules and so do all the nurses I've seen in my hospital. I think what you're witnessing is nurses making decisions based on culture rather than evidence and a concern for safest practice. You have the opportunity now to start standing out as a professional with high standards. If you don't feel it's safe, trust your instincts and to hell with peer pressure.

As for your second question... how many people out there crush and administer meds via gtube one at a time???? Sincerely curious.

[MrsEd]

I never used filtered needles, adds cost to the system, and the meds are sterile when you pull them out of the bottle.

as for the way others do their nursing..you have text book nursing. NOW its time to do real world nursing. Your classes were protected classes. your a rookie!

If they question what your doing, ask them how they do it! You will LEARN!

What does the fact that the meds are sterile when you draw them out of an ampule have to do with anything? And as others have said, you have to use a needle to draw up meds from an ampule, so why not just grab the filter needle? As far as I'm concerned practicing safely and being an advocate for your patient is REAL WORLD NURSING. And I certainly wouldn't advise taking advice from a nurse who cuts corners, especially when it's not necessary and not in the best interest of the patient.

[MassED, BSN, RN]

considers docs pulling up lidocaine from ampules without filter needles (for suturing)....

[RedhairedNurse, BSN, RN]

I always use filtered needles, but there are other's on my floor that do not use them. Our manager recently sent out a safety notice and encouraged all nurses to use them for the safety of the patient. If I were a patient, you can be **** sure that I'd want the nurse taking care of me to use a filtered needle!!

[muesli]

considers docs pulling up lidocaine from ampules without filter needles (for suturing)....

Yes but 1) isn't this SC administration you're talking about? I would imagine the microscopic tissue damage done subcutaneously would not have as significant an impact as IV administration which, as previous posters have noted can cause phlebitis and microscopic damage to your kidneys and other areas...(and in a non-emergent situation I would use filtered needles for that too)

and 2) doctors' habits aren't a great standard for clinical practice. Wasn't it Florence Nightengale who got all the MDs on board with washing their hands? I think as nurses we should strive to shape our practice based on research and our own judgment. Who's to say that this doctor does it that way because someone who was doing it erroneously taught him to do it that way?

[donsterRN, ASN, BSN]

I was taught that filter needles were the standard for drawing meds from a glass ampule. I've done it that way since school. Honestly, it wouldn't occur to me NOT to.