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Article Excerpt
The use of filter needles is not often considered when discussing medication preparation from glass ampules. Fundamentals of nursing references prior to 1999 typically do not acknowledge this as an important component of safe medication administration. Safe medication administration traditionally has been regarded as adhering to five rights (5Rs): right medication, dose, patient, route, and time. Adding a sixth right may be appropriate--the right technique in medication preparation.
The use of filter needles in aspirating parenteral medications from glass ampules was first recommended by Katz, Borden, and Hirscher (1973). This recommendation came from their observations during their anesthesia clinical practice that intravenous medications packaged in glass ampules often became contaminated with glass particles when opened. The American Society of Health System Pharmacists (ASHP) and the Infusion Nurses Society (INS) also offer current recommendations regarding the use of filter needles to remove tiny glass particles that result when glass ampules are opened (ASHP, 2000; INS, 2002). Glass particulate and bacterial contamination have long been recognized as hazards associated with ampules (Stehbens & Florey, 1960). IV administration of glass particles may lead to complications, including pulmonary thrombi and microemboli, infusion phlebitis, end-organ granuloma formation, and inflammation (Furgang, 1974; Garvin & Gunner, 1964; Rodger & King, 2000; Shaw & Lyall, 1985; Waller & George, 1986; Zacher, Zornow, & Evans, 1991).
The hazards of glass particulate contamination associated with glass ampules and the effectiveness of filter needles in decreasing such contamination are discussed. Strategies for compliance with filter needle use are highlighted.
Parenteral Medication Administration
The fundamentals. The knowledge and skills needed to prepare medication from glass ampules are taught early in nursing curricula. A review of several nursing fundamentals and basic skills textbooks revealed different perspectives regarding the use of filter needles to withdraw medications from glass ampules. Textbooks written from 1992 to 1998 (Baer & Williams, 1992; Craven & Hirnle, 1996; Elkin, Perry, & Potter, 1996; Kozier, Erb, Blais, Wilkinson, & Van Leuven, 1998; Perry & Potter, 1998; Taylor, Lillis, & LeMone, 1993) indicated that use of filter needles was optional. Books written from 1999 to 2005 (DeLaune & Ladner, 2002; Perry & Potter, 2002; Potter & Perry, 1999, 2003, 2005) recommended filter needle use when aspirating medication from glass ampules. This change may not have been communicated clearly to practicing nurses, who may consider use of a filter needle to be discretionary.
Even nurse educators and leaders do not seem to perceive the importance of filter needle use. During hospital orientation, the use of filter needles is not validated as a core competency, perhaps because of the assumption that students have already mastered this skill (Hadaway, 2003). A systems issue may...
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