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QUESTION: Our new OR director is concerned about how we draw up medications from glass ampules. She states that a needle filter should be used when drawing up medications from a glass vial. We have never done this at this facility. Some of the nurses who have worked in other facilities report that they used to draw up medications from glass vials using filters, but they were not sure where that recommendation came from. Should a needle filter be used when drawing up medications from a glass vial? Where does this recommendation come from? What is the rationale?
ANSWER: The American Society for Health System Pharmacists recommends filtering solutions drawn up from glass ampules to remove glass particles. (1) Opening a glass ampule produces a spray of tiny glass particles. Many of these fractured minuscule glass particles can enter the ampule and contaminate the contents. The size of the glass particles increases proportionally with the size of the vial. (2,3)
Animal studies have demonstrated that IV administration of glass particles is associated with pathological responses. Glass particles were found in the pulmonary capillaries, livers, kidneys, spleens, and intestinal walls of animals studied. The research demonstrated that glass particles caused inflammatory responses, thrombi, and foreign body granulomas. (2,3)
A study on glass particle contamination in glass ampules demonstrates that the mean glass particle count in ampules after they were opened was approximately 100.6 particles, ranging in size from 10 [micro]m per 10 mL to 1,000 [micro]m per 10 mL. Glass ampules with transparent metal etching produced significantly more glass particles. Aspiration of solutions from glass vials through an 18-g needle reduced the mean number of glass particles to 65.6 and decreased the maximum particle size to less than 400 [micro]m per 10 mL. Aspiration through a 19-g needle with 5-[micro]m and 0.22-[micro]m in-line filters decreased the mean total number of glass particles to 1.3 [+ or -] 0.3 and 1.2 [+ or -] 0.3 respectively. Particle size was decreased to less than 200 [micro]m. (3)
Data demonstrate that aspiration through a 19-g needle with a 5-[micro]m filter is an effective way of reducing glass particle contamination. It must be noted that after medication is aspirated into a syringe, the filter needle must be replaced with a standard needle before the medication is injected into a patient.
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