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.

[RNandRRT]

This was handled easily by my unit. We are almost completely a needleless institution. So the only needles available at the med station are the filter needles. Any SC or IM injections are done with syringes with the needles in the kit.

[muesli]

What I find interesting is that the same nurses who are calling the non-filter needle using nurses dangerous because there might be a problem no longer aspirate before injecting IMs and subQs because "it has not been proven it makes the shot safer". The "it might be bad so I won't do it" principle is not applied to the possibility that several molecules of the drug injected might find their way into a blood vessel and cause organ damage.

Good point... it may be my post you are quoting regarding the SC injection. I think I added that in a non-emergent situation I would use a filtered needle for any type of injection, because you're right; it hasn't been studied, and the recommendation by the manufacturer is still to use the filtered needle. It's not safe to "guess" what is safe and what is not if you can just as easily look up the rationale behind a recommended way to do things!

[SalishRN]

Yes, I always use a filter when when drawing up meds from an ampule.

[MassED, BSN, RN]

Many times I have given IV Ativan which requires puncturing the rubber stopper. On a few occasions a small piece of the rubber ends up in the syringe. When this happens, I will use a filter needle with another syringe to make sure the rubber piece is not in the syringe I plan on using with the pt.

I have NEVER had that happen. Ever.

????? I'm not saying it can't happen, just bizarre that some of the rubber would come off - maybe the rubber stopper was old/worn out... kinda like the cork on a wine bottle.

[MassED, BSN, RN]

NREMT-P/RN

Hi, we agree on filter needles.

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.

side note here - we have Pediatric code carts with meds color coded to avoid having to measure out meds during a code (braslow cart color coding) - and there are no rubber stopper on Epi and Atropine, they're prefilled syringes, you pop the top off and connect to the port (you can use the needle there or twist it off and connect to the port, depending if the kid came in with EMS with THEIR tubing (usually never compatible).

[MassED, BSN, RN]

I didn't say it wasn't possible, just that I would be interested to see it, and I didn't say using a filter needle was a bunch of hooey, either, as some other posters did.

In the case of someone jumping out of an airplane, we do have actual data in the form of mishaps with the opening of a parachute telling us that 100% of the time if you free fall from an airplane you will die when you hit the ground. The cause and effect relationship is made pretty easily.

To say that when glass particles of several microns being linked to phlebitis in a cow when the particles are injected intravenously is "injecting glass shards into your patient" requires quite a bit more conjecture.

[MassED, BSN, RN]

For those that have nothing better to do right now...or for the curious...

http://en.wikipedia.org/wiki/Nick_Alkemade

Alan Magee - Wikipedia, the free encyclopedia

Ivan Chisov - Wikipedia, the free encyclopedia

Pretty amazing stuff...

I love resourcefulness. I'm all about finding little known facts/info. Love it! Thanks! Those are some amazing stories!!!

[Deb123j]

I have NEVER had that happen. Ever.

????? I'm not saying it can't happen, just bizarre that some of the rubber would come off - maybe the rubber stopper was old/worn out... kinda like the cork on a wine bottle.

It's happened maybe 3-4x's in the past almost 3 years. We use a larger needle (16g I believe) to draw up our meds, so maybe that is why. But I always look to make sure my syringe is clear. And...of course I use the filter when using a glass ampule. Sometimes we are lucky enough to get fentanyl in glass bottles with rubber tops, but mostly the ampules. I work on a trauma unit and we use TONS of ativan & fentanyl.

[nursel56]

I have to go back and change my answer :o:o as AirforceRN has provided us with incredibly odds-defying instances of people surviving falls of between 18,000 and 22,000 feet! Does anyone remember if DB Cooper's remains were found? Maybe he really is living it up in Rio or somesuch.

.

[Asystole RN]

I have to go back and change my answer :o:o as AirforceRN has provided us with incredibly odds-defying instances of people surviving falls of between 18,000 and 22,000 feet! Does anyone remember if DB Cooper's remains were found? Maybe he really is living it up in Rio or somesuch.

.

No they were not but a pamphlet from the plane and $6,000 of the original $200,000 was found.

He may be living it up, if only on $5k a year...Rio's cost of living is fairly low

[Asystole RN]

It's happened maybe 3-4x's in the past almost 3 years. We use a larger needle (16g I believe) to draw up our meds, so maybe that is why. But I always look to make sure my syringe is clear. And...of course I use the filter when using a glass ampule. Sometimes we are lucky enough to get fentanyl in glass bottles with rubber tops, but mostly the ampules. I work on a trauma unit and we use TONS of ativan & fentanyl.

16g!?!?

Why don't you just use a drinking straw to pull it up? lol

[brownbook]

Hi, MassED ,

Hate to hijack this thread but with PALS. Yes we know about the color coded tape and pre-packaged packs. However we were told they cannot pre-package medication in these packs because it would be very expensive and the drugs would, could, expire. The epinephrine we practiced with comes in a pre-filled 10ml syringe that has a needless tip. Do you have access to pre-filled epi syringes that already have 1.0 - 1.2 - 1.3 - 1.4 - etc epi syringes in them????? If so, where did you get them???? Don't they expire unless you run a lot of codes? If you don't have pre-filled syringes how do you inject 1.2 ml of epi from a 10 ml syringe? Isn't it hard to push that exact amount especially in a code?????