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LETTERS TO EDITOR
Year : 2022  |  Volume : 23  |  Issue : 1  |  Page : 74-75
 

Filter syringes: Knowing the unknown


Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Date of Submission11-Aug-2021
Date of Decision08-Feb-2022
Date of Acceptance08-Feb-2022
Date of Web Publication23-Mar-2022

Correspondence Address:
Dr. Manbir Kaur
Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TheIAForum.TheIAForum_117_21

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How to cite this article:
Shekhawat A, Kaur M, Sethi P, Bhatia P. Filter syringes: Knowing the unknown. Indian Anaesth Forum 2022;23:74-5

How to cite this URL:
Shekhawat A, Kaur M, Sethi P, Bhatia P. Filter syringes: Knowing the unknown. Indian Anaesth Forum [serial online] 2022 [cited 2022 Jul 5];23:74-5. Available from: http://www.theiaforum.org/text.asp?2022/23/1/74/340488




Sir,

There has been a rising trend in the practice of medicine to err on the side of safety. In that context, via this article, we would like to discuss whether the practice of using specialized filter needles to aspirate drugs from breakable glass ampules should be more prevalent or not.

Many drugs are manufactured as a glass ampule due to the benefits of easy portability and high sterility standards. These glass particle contaminations (GPC) may be introduced either during manufacturing, opening, or injection. The American Society of Health-System Pharmacists (ASHP) guidelines recommend using a 5μm filter needle to minimize particulate contamination risk.[1]

These particles can cause pain at the injection site, infusion phlebitis, tissue injury, necrosis, pulmonary thrombi and micro-emboli, end-organ inflammation (kidney, liver, spleen, and lungs), granuloma formation, and modulating inflammatory effects, especially in at-risk patient groups like neonates and those receiving long term intravenous drugs.[2],[3]

Multiple studies have shown that filter less aspiration of drugs from glass ampules leads to, at the very least, tens and at most, hundreds of glass particulates being injected in patients. The size of the particles ranging from 2μm to 500μm.[4],[5]

Filter needles [Figure 1] are not used in India's routine practice because the risk of glass contamination is often not known or often overlooked by medical practitioners. They are expensive and cumbersome to use, which leads to reluctance on the practitioner's part. Awareness on this topic is also low, leading to a callous attitude towards the contaminants' risks. The probability of misdiagnosing and misattributing the detrimental effects of particulate matter would be very high since particulate contamination is rarely if ever, considered in the differential diagnosis.
Figure 1: (a and b) shows the filter (front and back side, respectively) and (c) shows filter syringe (filter attached to syringe) with needle

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Hence it is always recommended to be safer than necessary and err on the side of caution and bring into practice filtered needles for aspirating from glass ampules.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
American Society of Health System Pharmacists. ASHP guidelines on compounding sterile preparations. Am J Health Syst Pharm.2014;71(2):145-66  Back to cited text no. 1
    
2.
Caudron E, Tfayli A, Monnier C, Manfait M, Prognon P, Pradeau D. Identification of hematite particles in sealed glass containers for pharmaceutical uses by Raman microspectroscopy. J Pharm Biomed Anal. 2011;54:866-8.  Back to cited text no. 2
    
3.
Chiannilkulchai N, Kejkornkaew S. Safety concerns with glass particle contamination: improving the standard guidelines for preparing medication injections. Int J Qual Health Care. 2021;33:mzab091.  Back to cited text no. 3
    
4.
Joo GE, Sohng KY, Park MY. The effect of different methods of intravenous injection on glass particle contamination from ampules. Springerplus. 2016;5:15  Back to cited text no. 4
    
5.
Sabon RL Jr, Cheng EY, Stommel KA, Hennen CR. Glass particle contamination: influence of aspiration methods and ampule types. Anesthesiology. 1989;70:859-62  Back to cited text no. 5
    


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