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.
Specializes in Pre-Op/PACU, Infusion Therapy, Endoscopy.
If there's an option to use a filter needle and non-filter needle.....I would certainly use the filtered needle as best practice, simply because the filter needle is adding that extra 'component' of safety. Who wouldn't...it changes nothing in manual process, but has an added measure of safety!
Specializes in Psych/CD/Medical/Emp Hlth/Staff ED.
The question you should be asking is: Are ampules necessary?
The answer so far: No.
Feel free to convince me otherwise.
As much as we all hate them, there are a few reasons why glass ampules still exist. The primary reason is that some medications just cannot be stored in any type of plastic. NTG for instance is absorbed by plastic over time. It's not a significant amount when running through plastic IV tubing, but if it was stored in a plastic bottle or bag then the actual concentration would vary significantly by the amount of time it had been in contact with plastic until there was essentially no active medication left in the solution. Even worse, some medications not only become less effective when in contact with plastic, but they can actually become potentially harmful. Some medications react with some plastics but not others, such as Aviva plastic.
Another argument for glass is that rubber stopper vials are universally seen as multi-dose, even though some medications stored in them become inactive even after a small amount of oxidation, glass ampules have the advantage of being single dose by their design.
There are even arguments that more medications should be stored in glass vials for other reasons; I heard of a nurse who emptied out all the morphine and dilaudid PCA syringes through the rubber stoppers and refilled them with NS, which can also be done with carpujects and vials, but not with ampules.
I absolutely agree that for storage reasons, we still need to use glass, although I don't know that I would advocate putting all narcotics in sealed glass just for security or as a replacement for education on multi-dose vs single dose vials, but they are both arguments out there for the continued use of glass.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I will use a filter needle if my facility buys them, but I would love to see one actual documented case of a human being harmed by a medication given from an ampule without a filter needle.
Trust me on this one, YOU WILL NOT HAVE TIME to use a filter,yes ideally it should be used in some situations, however, in the last 5 facilities I have worked at, filters arent even available.Best of luck in the real world,its gonna suck.
Specializes in acute care med/surg, LTC, orthopedics.
Another argument for glass is that rubber stopper vials are universally seen as multi-dose, even though some medications stored in them become inactive even after a small amount of oxidation, glass ampules have the advantage of being single dose by their design.
Where I'm from, rubber stopper vials are universally seen as single-dose with big red letters "single use only" plastered on the label - in fact, assume single use only unless otherwise specified.
I can understand that plastics can and do interfere with stability/integrity of certain meds, but in my opinion there are too many meds stored in glass that don't (scientifically) need to be.
I dislike glass ampules too, don't know how many times I've cut myself on those bloody things...
Regarding filter needles in PALS. I am NOT a paramedic or ER nurse and my only exposure to PALS is I have to re-certify every two years, I've (thankfully) never had to use it. So don't quote me on this!!!!
The epinephrine comes in pre-filled syringes, epi 1-10:000 in a 10 ml syringe. It has a plastic/rubber type stopper at one end. The other end is a needless system to connect to the IV port. Standard IV tubing with needless injection access ports are used.
A 14 kilogram child would need 1.4 mg of the solution. REALLY hard to give that exact amount from a 10 ml syringe. It was recommended to use a smaller syringe (probably 3 cc) to draw up the 1.4 ml from the rubber/plastic end. As I said it was mentioned a filter needle was recommended to draw up the solution. Injecting the solution is done without the needle through a needless access port on the IV.
Much as I think filter needles should be used in routine situations with glass ampules I (and the instructors) thought that was taking things to far, we're in a pediatric code for heaven sakes!
As for other comments, why even have glass ampules, or injecting WITH the filter needle.
Where I work we give a lot of fentanyl, it seems to only come in glass ampules.
Our IV tubing has needless injection ports, if we add a stop cock extension to it, will have a rubber capped port a needle could go through. However NEVER NEVER NEVER would I (or anyone) have a need to inject with the filter needle through that port??? The filter needle is removed and the needless port is accessed with the syringe.
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?
good point regarding sc vs IV, but I've never seen any doc use a filter needle in the ED - for any procedure.
The question you should be asking is: Are ampules necessary?
The answer so far: No.
Feel free to convince me otherwise.
sometimes those are the only packaging available - for instance carpujets or ampules of Morphine. It depends (for me in the ED) of which med is available, Morphine 2 mg might be in ampules and Morphine 4 mg might be in carpujets. I prefer not to use ampules mainly because you have to break it and I've cut my fingers a few times, even using alcohol wipe packaging as a barrier.
Specializes in Psych/CD/Medical/Emp Hlth/Staff ED.
I will use a filter needle if my facility buys them, but I would love to see one actual documented case of a human being harmed by a medication given from an ampule without a filter needle.
While it is true there are no RCT's involving the injection of glass particulates in humans for the final confirmation of a risk, there are also no RCT's that compare jumping out of a plane with a parachute to jumping out of a plane without a parachute. So no, there is no true scientific evidence to confirm any increased safety of using a parachute when jumping out of a plane either.
What we do know is that a significant amount of glass shards are drawn up when using a glass ampule without a filter and that this causes harm to other animals. Should the burden of proof lie with proving it's safe to inject the glass shards or with proving it's unsafe in humans? For me, I'm probably going to continue to wear a parachute, even in the absence of a confirmed risk, until it's safety can be proven given the logical risks of falling out of the sky with no parachute, or having glass shards in your circulatory system.
Randy.RN
15 Posts
If there's an option to use a filter needle and non-filter needle.....I would certainly use the filtered needle as best practice, simply because the filter needle is adding that extra 'component' of safety. Who wouldn't...it changes nothing in manual process, but has an added measure of safety!