Glass ampules and filter needles: an example of implementing the sixth 'R' in medication administration
MedSurg Nursing, Oct, 2006 by Heidi G. Stein
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Glass particulate contamination. Glass ampules are effective in preserving the purity and shelf life of liquid parenteral medications. Powdered preparations are rarely packaged in ampules. The composition of glass ampules is type 1 grade borosilicate glass, which can be clear or amber, and is scored either chemically or by metal etching (Sabon, Cheng, Stommel, & Hennen, 1989). Prescored ampules, which are usually colored around the neck, break easy without filing. They are available in a variety of sizes (1-10 ml), and with different types of stems (straight and closed) and tips (funnel, double, or fine) (DeLaune & Ladner, 2002).
Research confirmed the multiple potential problems associated with the use of ampules. After an ampule is broken, glass particles can contaminate the solution in the ampule (Furgang, 1974; Gillies, Thiel, & Oppenheim, 1985; Kempen, Sulkowski, & Sawyer, 1989; Preston & Hegadoren, 2004; Turco & Davis, 1972), causing inflammatory changes in both animals (Dorris et al., 1977; Stehbens & Florey, 1960) and humans (Garvan & Gunner, 1964). Glass ampules are not only a potential source of glass fragments but also a source of infectious agents which can contribute to granulomatous lesions in the lung, brain, spleen, and kidney (Garvan & Gunner, 1964). Studies using the animal model also have identified inflammatory changes in the venous endothelium (Dorris et al., 1977; Stehbens & Florey, 1960). With increased infusion time and concentration of particulate matter, reactions can become severe.
Bacterial contamination. Identifying bacteria-contaminated glass fragments (Kempen et al., 1989) prompted the recommendation for filter needles even though it was known that their use would not eliminate the problem entirely. A study by Zacher and coauthors (1991) identified that bacterial contamination through introduction of glass fragments into the drug solution can be minimized by swabbing the neck of the ampule with alcohol before breaking it. Microbial contamination also can occur when using ampules stored in dusty shelves, touched by dirty hands, or held in unsterile gauze, and from needles that come in contact with the external surface of the ampule during the process of withdrawing the drug (Kempen et al., 1989).