Needle filters; moisture inside wrapped sets; weight of instrument sets; internal indicators; transporting wet sets - Clinical Issues

AORN Journal,  Dec, 2003  by Carol Petersen

• E-mail
• Print
• Link

QUESTION: Our new OR director is concerned about how we draw up medications from grass ampules. She states that a needle filter should be used when drawing up medications from a grass 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 fitter 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.

QUESTION: We have noticed that some of our wrapped instrument sets have small amounts of moisture on the inside. Sometimes the wrapper still is very warm when we receive the sets from the central processing department (CPD). Some staff nurses think it is acceptable to use the set if the outside of the wrapper is dry. I was taught that if an item is wet or damp, it is not sterile. After numerous discussions, we cannot seem to agree on the best approach. What does AORN recommend? If the wrapped instrument set is only slightly damp on the inside but the outside is dry, is it acceptable to use the instruments?

ANSWER: A sterile, wrapped set with moisture or dampness on the inside should be rejected even if there is no evidence of wetness on the outside. Moisture, whether on the inside or the outside, causes a wicking effect and provides access for microorganisms to enter and contaminate the sterile set. The pack may have been wet on the outside and dried before it was opened. Regardless of the location, wetness or dampness creates doubt about the sterility of the set, and it should be considered unsterile. (4)

Wrapped items that still are very warm should not be handled. All items removed from the sterilizer after the sterilizing process should remain on the sterilizer cart until they are cooled adequately. Warm items should not be handled, touched, or moved to another cart until they have cooled completely. At the end of a sterilization cycle there still is some steam vapor in the packages. Hot packs act as wicks when touched, absorbing moisture and bacteria from hands. Transferring hot items to a cold cart also causes condensation to develop, which may result in a wet, contaminated pack. During cooling, the sterilizer cart should be left in the sterilizer with the door open or placed in a low-traffic area until it is completely cool. (4-6)

QUESTION: Some of our instrument sets are extremely heavy. We are concerned that someone will injure his or her back or that the sets will not be sterile as a result of this extreme weight. Is there a weight limit for an instrument set?

ANSWER: No particular instrument weight is specified in AORN's standards and guidelines. The weight of an instrument set should be based on the number of instruments, total weight, and density. Sets should be of a size that easily and safely can be lifted using good body mechanics, without endangering the safety of employees or compromising the sterility or integrity of the sterile wrap. If sets are too heavy, they may be dropped or the sterile wrapping may be torn as sets are dragged across shelving, causing damage to the instruments and possible employee injury. If the weight of instrument sets is causing back injuries or a need for resterilization, it may be in the best financial interest of a facility to assist and support staff members by reducing the size of the sets.