about injections: are filters important for ampuled drugs?

Nurses General Nursing

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I have to give a lot of b12 shots out of ampules, but we don't ever use filters. I know how school teachings can differ from "real life", but I'm nervous about not using them. I read that microscopic shrapnels can contaminate the liquids when breaking the ampules, and that these could cause them to dislogde somewhere unpleasant in the body. Can any please help tell me what their experience has been?

Specializes in Medical.

I'm with Amy - we don't use them either. We do have a filter system when drawing up some drugs on immunocompromised(that doesn't look right!) patients, but it has to be for some other reason, because I can't imagine that they're more at risk of glass-fragment injury! Oh, and drawing up factor VIII.

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Specializes in Renal, Haemo and Peritoneal.
The use of a filtered needle has NOTHING to do with teaching a patient how to give epo or whether a diabetic has perfect technique. We are not talking about vials. We are talking about single use GLASS AMPULES.

A filtered needle is used when you break a GLASS ampule and then draw up your medicine from that ampule. It prevents any microscopic pieces of glass from entering into your syringe and then into a patients vein, which can then travel to another location in their body. If this occured because you did not use a filtered needle, you better believe you would have a legitimate lawsuit on your hands.

Please familarize yourself with the use of filtered needles. If an adverse effect occured because you did not use a filtered needle when indicated (glass ampules), it would not be "bad luck", it would be poor nursing.

Are filtered needles only for IV injections?

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Specializes in Medical.

PS - I work in an acute hospital, give IV/IM/SC meds drawn up from glass ampoules every day, and have never heard of any complications. Does any one know of a case where this was an issue, or any empirical literature?

Also, have just done a poll of our night staff - no from the NZ representative, no from the other Aussie (who's also worked in Europe, but that was many moons ago), and yes from our South African RN, who was surprised when she started here, but isn't concerned now (some two years in Aus)

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Wow, I envy you so much! CRNA...is it as hard to get into CRNA school as they say it is?

CRNA school is very tough to get into. I'm not there yet, but working on it as best I can. I hope to be in school next year after I finish my year requirement in ICU.

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Specializes in NICU.
Are filtered needles only for IV injections?

No, they're for any medication drawn from a glass ampule after breaking off the tip. The only ampule we normally use in the NICU is Vitamin K, and that's an IM injection.

We actually just started using filter needles a few months ago. I don't know what happened to change our former practice, but I was happy to see them on the unit. However, we've always used 25 gauge needles for IM injections on our babies, and I can't imagine any piece of glass being able to get through that tiny sucker!!!

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... Does any one know of a case where this was an issue, or any empirical literature?

Just did a search on CINAHL & Medline and came up with nothing; however, I did find this "Ask The Expert" article from the AACN (American Association of Critical Care Nurses):

AUGUST 98 - VOLUME 18 - NUMBER 4

FILTER NEEDLES AND GLASS AMPULES

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

  1. Turco S, Davis NM. Glass particles in intravenous injections. N Engl J Med. 1972;287:1204-1205.
  2. Carbone-Traber KB, Shanks CA. Glass particle contamination in single-dose ampules. Anesth Analg. 1986;65:1361-1363.
  3. Waller DG, George CF. Ampules, infusions and filters. Br Med J. 1986;292:714-715.
  4. Kempen PM, Sulkowski E, Sawyer RA. Glass ampules and associated hazards. Crit Care Med. 1989;17(8):812-813.
  5. Sabon RL, Cheng EY, Stommel KA, Hennen CR. Glass particle contamination: influence of aspiration methods and ampule types. Anesthesiology. 1989;70(5):59-62.
  6. 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.

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CRNAsoon - Thank you for research.

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Specializes in Medical.

Thanks for that article, CRNA - interesting, I'll have to give the issue some more thought. Hmm.

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I'm gonna have to revisit this, as well, and check with my facility. Surely we have these needles somewhere.

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Specializes in private duty/home health, med/surg.

Great article, CRNA--thanks for finding & posting it for us.

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I've always used filter needles when drawing from glass ampoules.

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I would refuse to draw from glass ampules without a filter - it doesn't seem worth the risk not to.

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