Filters for peds patients

Posted
by sarasa sarasa (New) New

I was working a shift in an ER and an ER nurse insisted that we needed a filter to reduce the risk of air bubbles. They also wanted to put it on a syringe pump which peds said they do not use them on the pumps. 

Looking online, I found an article from 1998 that said they didn't see any difference in septicemia and they discontinued the filters for pediatrics. Then one site said that filters should be used on all arterial lines (I have never seen a set with a filter for an adult) and cardiac patients but did not say if it is an adult or pediatric patients. 

Granted, I am pretty sure this hospital system still rotates IVs every 4 days so I am not sure if they are up on the latest guidelines. Is it still standard practice to use filters? 

chare

3,582 Posts

On 6/18/2021 at 4:16 PM, sarasa said:

I was working a shift in an ER and an ER nurse insisted that we needed a filter to reduce the risk of air bubbles. They also wanted to put it on a syringe pump which peds said they do not use them on the pumps. 

[...]

The intent of a filter needle or straw is to filter particulate matter, not air.  These should be used primarilybwhen drawing medications from an ampule, although an argument could probably be made for using them with reconstituted medications as well.

As for using a syringe pump, this is more of a concern with neonates due to an increased risk of intraventricular hemorrhage with too rapid administration of some medications.

On 6/18/2021 at 4:16 PM, sarasa said:

[...]

... Then one site said that filters should be used on all arterial lines (I have never seen a set with a filter for an adult) and cardiac patients but did not say if it is an adult or pediatric patients. 

[...]

This is likely referring to using a filter on the arterial, or return side, during cardiopulmonary bypass, although there is some indication that this is no longer necessary using current oxygenator technology.

As for a filter on a peripheral arterial line, I have never seen this in over 15 years in the PICU.

Best wishes.

adventure_rn, BSN

Specializes in NICU, PICU. 1 Article; 1,544 Posts

18 hours ago, chare said:

The intent of a filter needle or straw is to filter particulate matter, not air.  These should be used primarily when drawing medications from an ampule, although an argument could probably be made for using them with reconstituted medications as well.

I think the OP is referring to filters on IV tubing, not filter straws/needles.

Most of my experience comes from NICU (although I do have some Peds Cardiac ICU experience); all of my peds units across three hospital systems have used air filters on all of our IV tubing (venous, arterial, central, peripheral). Some had the filter manufactured directly into the primary tubing/spiker set, and others had a filter attachment that we added in between the primary tubing and the t-connector.

There shouldn't be any effect on septicemia; it's all about the risk of an embolism, which is higher in kids because their vessels are smaller. Filters/bubbles are actually more dangerous in venous lines than arterial lines, and more dangerous in neonates and kids with congenital heart defects than the pediatric population at large. (I'm happy to explain the physiology if you're interested.)

I'm not sure which pump brand you use, but for our Alaris pumps, the main benefit of the syringe pumps is that you can run tiny, precise med doses/drips. The regular pumps can only round to the .00 mL/hr decimal place, whereas the syringe pumps can go to .000 mL/hr. Drips that run at less than 0.1 mL/hr literally cannot be programmed into the regular pumps. It isn't a huge deal for maintenance fluids, but if you tried to start a prostaglandin drip on a 1 kg baby, the pump literally would not run.

Also, in NICU (and most of peds cardiac) our meds are drawn up by pharmacy in syringes, so there'd be no other way to give them besides a syringe pump (unless you want to spend an hour pushing your vanc by hand at 0.1 mL every 5 mins).

Edited by adventure_rn