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Is it absolutly neccasry to swap out the needle after I draw it?

Posted
bjware bjware (New) New

I would like to see factual data that say's I need to swap out my needles after I've drawn them. If any one can point me in the proper direction for this information I would greatly appreciate it. My office staff is divided on this issue and I've become annoyed with the indecisiveness surrounding the issue.

Thanks

BJW

Marie_LPN, RN, LPN, RN

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

Think of it this way: you use a needle to draw out a medicine, and in the process, the tip of that needle is duller. Would you want that put into YOUR skin?

austin heart, BSN, RN

Specializes in ICU.

I agree with Marie, plus there is a greater chance of contamination.

SmilingBluEyes

Has 20 years experience.

i agree w/the other posters. I always change out needles. Welcome to allnurses.com

and I look forward to hearing more from you on our many forums.

hrtprncss

Specializes in ICUs, Tele, etc.. Has 15 years experience.

You're talking about IM's only right, yes I probably would consider it during an IM but I don't change it ALL the time. I mean do you guys change needles after drawing when giving IVP on rubber tipped ports? How bout Insulin syringes, some of them are not interchangeable, and the one's where you can take the needle off, usually you'd have to open up a new package to get the needle and thus waste the new syringe.

Marie_LPN, RN, LPN, RN

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

I mean do you guys change needles after drawing when giving IVP on rubber tipped ports?

Yes. The only ones i haven't changed are the insulin needles.

sbic56, BSN, RN

Specializes in Obstetrics, M/S, Psych. Has 24 years experience.

I couldn't find much stating it is necessary or helpful to change needles between drawing up and injecting. Found one saying it may help. Personally, I doubt it would be any more painful as the stopper is not going to dull the needle enough to cause more discomfort. Certainly, I check it first, but do not generally change the needle. Technique is most important with an injection; poor technique is more likely the reason for a painful injection. I know of diabetics who reuse insulin needles (questionable practice, I know, but it's the cost factor) and dullness is not an issue.

http://www.health.gov.nl.ca/health/publications/immunization/S4/immunization_injection.htm

Changing Needles - if the integrity or sharpness of the needle is in question it should be changed otherwise no reason to do so. To change the needle after drawing up may also be an advisory in the product monograph.

http://www.immunize.org/catg.d/p2021f.htm

Is it recommended to change needles after a vaccine dose has been drawn into a syringe? No. Also, it is unnecessary to change the needle if it has passed through two stoppers, which is done when a lyophilized vaccine is reconstituted. Changing needles is a waste of resources and increases the risk of needlestick injury. (4/03)

http://www.fertilityplus.org/faq/ivfhints.html

The needle gauge is not important to the shot, but it may be important for pain. The larger number, the smaller the needle. (A 27-gauge needle is smaller than a 22 gauge.) If you use a different needle for drawing the

medications and shooting, it may help, too.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10636960&dopt=Abstract

CONCLUSION: Changing the needle before the administration of subcutaneous heparin did not decrease the size of ecchymoses as compared with the size to the size of ecchymoses when the investigator did not change the needle.

http://www.ingentaconnect.com/content/bsc/anm/2000/00000009/00000003/art00176

Traditionally nurses have used one of two drawing up techniques for the administration of intramuscular (IM) injections. In the first, the injectable is drawn up using one needle, which is then discarded before administration using a new needle. Alternatively, the injectable is drawn up and administered without changing the needle. Advocates of the two-needle technique suggest that this method reduces pain at the injection site. In the present study, 70 subjects completed an independently validated pain scale following administration of an IM depot neuroleptic. The conclusion, that there is a significant reduction in injection site pain, using the two-needle technique, is not supported by the data obtained in this study.

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

There is also the issue of tiny bits of broken glass falling into the medication when using ampules.......you certainly don't want to inject that into someone, whether IM or IV.

Personally, I always change the needle after drawing up IM meds, plus I wait for the alcohol to dry on the skin before injecting. Both actions prevent the tracking of irritating substances through the tissues, which can greatly reduce discomfort at the injection site. (I know the vast majority of my patients appreciate it, anyway. :) )

sbic56, BSN, RN

Specializes in Obstetrics, M/S, Psych. Has 24 years experience.

There is also the issue of tiny bits of broken glass falling into the medication when using ampules.......you certainly don't want to inject that into someone, whether IM or IV.

Personally, I always change the needle after drawing up IM meds, plus I wait for the alcohol to dry on the skin before injecting. Both actions prevent the tracking of irritating substances through the tissues, which can greatly reduce discomfort at the injection site. (I know the vast majority of my patients appreciate it, anyway. :) )

Good points about glass shards and the alcohol. I use a filter needle with amps. I'm suprised to learn so many are changing needles after piercing stoppers, though. If I thought it made a difference, I certainly would change the needle. I get mostly "I hardly felt that" comments, so I think I'm alright. Quick is key. :) Still, I would be receptive, if I saw some good documentation saying it really makes a difference. Change can be, often is, a good thing! I just couldn't find anything that says it does make a true difference, and like the OP, I'd like to see it.

Guitar_Heroine

Specializes in Med-surg. Has 6 years experience.

poor technique is more likely the reason for a painful injection.

Would you mind elaborating about technique? I wasn't taught anything more than to use a "smooth darting motion" and of course pinching for sub-q and z-track for IM. Are there more tricks to it? I ask because I was very discouraged by my first injection - insulin to the arm and the patient jumped when I poked him. People in the room tried to tell me he was kidding because he knew it was my first time but I'm still worried I'm doing something wrong.

personally I won't change the needle, I agree with sbic56 - the method of giving an injection is more important so as to reduce pain and discomfort.

I don't think it's really neccessary to change the needle at all.

sbic56, BSN, RN

Specializes in Obstetrics, M/S, Psych. Has 24 years experience.

Would you mind elaborating about technique? I wasn't taught anything more than to use a "smooth darting motion" and of course pinching for sub-q and z-track for IM. Are there more tricks to it? I ask because I was very discouraged by my first injection - insulin to the arm and the patient jumped when I poked him. People in the room tried to tell me he was kidding because he knew it was my first time but I'm still worried I'm doing something wrong.

It could be that the patient was having fun at your expense as a newbie, especially if he was used to getting insulin. (I never wanted my patient to know they were a first for anything they received from me!) Those microfine needles are not exactly painful, except to a few with a true needle phobia. Then, irregardless of technique, those phobic folks will probably jump some. As far as tricks, I wouldn't say there are many, but to go at it with confidence and insert the needle quickly and smoothly without hesitation. It is something like shooting darts. Do it with enough force so you don't just bounce off the skin...some people have amazingly tough skin and when they tense the muscle beneath, it's worse. It's important to size up your patient and know that a muscular guy is going to have a much tougher muscle than a soft elderly woman...one may be the texture of steak while the next is like butter! Then you will meet the frail old man that you may not be able to insert the entire needle into as you won't want to hit bone! With these very thin patients, a shorter needle may be indicated. Once poised and ready, exude calm; talk to them to relax them and take their mind off the procedure. Let them know they are going to feel a pinch, so you don't take them totally by suprise, but don't give them time to anticipate it much either. Like was said above, let the alcohol dry before breaking the skin. Like anything, it's the same with giving injections...practice makes perfect. Before long it will be almost automatic. :wink2:

There is also the issue of tiny bits of broken glass falling into the medication when using ampules.......you certainly don't want to inject that into someone, whether IM or IV.

Personally, I always change the needle after drawing up IM meds, plus I wait for the alcohol to dry on the skin before injecting. Both actions prevent the tracking of irritating substances through the tissues, which can greatly reduce discomfort at the injection site. (I know the vast majority of my patients appreciate it, anyway. :) )

I'm sorry if I missed something, but it sounds like you are saying that you don't use a filter needle to get something out of an ampoule? Is that right?

I was taught the following

1. Change my needle after drawing up medication.

2. Always use a filter needle when drawing from an ampule.

If you don't change your needle it can be dull or medications such as phenergan (if you stuck your needle in it) can harm the skin and the sub q as it passes thru.

Insulin is the only medication that I don't change my needle, because I can't.

elizabells, BSN, RN

Specializes in NICU.

I hurt my first subQ heparin patient too. He pulled away while the needle was still in and I felt it dragging out of his skin. I felt awful...

fluffwad

Specializes in MDS coordinator, hospice, ortho/ neuro.

My facility uses a brand of syringes where the needles cannot be removed. I was not taught to change needles......I was taught to use ' a smooth darting motion' and I can give IM and SQ injections that are hardly felt. In 22 yrs have only had an injection bounce once.

It makes me NUTS to watch some one insert the needle slowly.

hrtprncss

Specializes in ICUs, Tele, etc.. Has 15 years experience.

Personally to lessen the pain during an IM injection....I pinch the muscle a few times for a few seconds...of course telling the patient you're going to pinch them. Anyways after a few pinches, the sensation will be a bit numbed(actually ok not numb but a bit of pain from the pinch) from the needle poke. I've read it somewhere before a long time ago....And it has worked for me....Alot of patient say ''I didn't feel it much going in''. If you ever need a shot given to urself, ask the nurse to do that and see if there's any difference.

Personally, I hate injections so I like them to be as painless as possible. Especially on children. One of the first IMs I did was rocephin. I drew up the lido, put it in the AB shook it up then drew it up in the syringe. Not changing the needle (I forgot), it literally bounced off the buttocks when I went to inject. I did have to push harder than normal to get the syringe in. I felt bad, but the pt was actively dying and did not notice. Changing the needle only takes a second and if it means more comfort I'm all for it. On a diabetic needle, the diameter is so small it doesn't matter.

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