Water for Injection

[Anonymous]

Hi everyone,
Just wanting your thoughts, advice and experience regarding:
Water for Injection ampules which attach directly to syringe V Water for Injection ampules that do not attach and require drawing up needle?
Is one better than the other in terms of best practice or is it personal preference?
thanks
Cate Coffey | Clinical Nurse Consultant
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hopsital, Gap Rd, Alice Springs
GPO Box 2234, Suburb, NT Postcode
p … 08 89517737
e … cate.coffey@nt.gov.au http://www.nt.gov.au/health

Our Vision: Better health outcomes for all Central Australians
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[Tim Spencer]

Hi Cate,
There is moderate risk of syringe tip contamination when connecting directly to the plastic ampules – especially if using the luer-lock style syringes (but also the plain lure-slip) – although this is a widespread clinical practice, it also poses significant contamination risk on behalf of the user, especially during emergent situations.
At the moment, I think it comes down to the overall clinician preference, however, the blunt cannula technique to draw up the fluid does pose potentially less contamination risk in my opinion.
It has been a mixed issue on both techniques for many years which probably has not been looked at closely before.

I also reviewed the INS Standards of Practice (2016) and the recommendations are to use a blunt drawing device, filtered needle or straw for removing contents from an ampule (doesnt specify plastic or glass ampules, however plastic ampules are not used in the USA) – those are only used for inhalation drugs or ophthalmology drops as single dose containers. Glass ampules or rubber stoppered vials are what we have in USA, plus absence of published evidence on their (plastic ampule) use.

So, to draw any fluid out of the ampule, you would need to use a needle, filter needle or straw carefully inserted into the open ampule and withdraw the fluid. Filter not needed unless that are very small plastic particles that can fall into the solution (or for a glass ampule) being careful to prevent contamination of the needle as it is placed into the ampule.

INS Standards of Practice 2016

Practice Criteria

A. Use sterile medications that were compounded in a pharmacy environment that meets USP , state pharmacy rules and regulations, and ASHP guidelines. The compounding environment is defined by risk category.1-4 (V, Regulatory)

1. Use pharmacy-prepared or commercially avail- able prefilled syringes of appropriate intravenous (IV) solution to flush and lock vascular access devices (refer to Standard 40, Flushing and Locking).

B. Begin the administration of an immediate-use compounded sterile product (CSP), as defined by USP , within 1 hour after the start of the preparation, or discard.1-3 (V, Regulatory)

C. Administer IV push medication in a safe manner:
1. When it is necessary to prepare more than 1 medication in a single syringe for IV push administration, limit preparation to the pharmacy.5 (V)

2. In adults, use IV push medications in a ready-to- administer form (to minimize the need for manipulation outside the pharmacy sterile compounding area).5 (V)

3. If dilution or reconstitution of an IV push medication becomes necessary outside the pharmacy sterile compounding area, perform these tasks immediately prior to administration in a clean, uncluttered, and functionally separate location using organization-approved, readily available drug information resources and sterile equipment and supplies.5,6 (V)

4. If more than 1 syringe of medication or solution to a single patient needs to be prepared at the bedside, prepare each medication or solution separately, and immediately administer it before preparing the next syringe. If preparing several IV push medications at a time for sequential IV push administration, label each syringe as it is being prepared and prior to the preparation of any subsequent syringes. If 1 or more medications or solutions needs to be prepared away from the patients bedside, immediately label each syringe, 1 at a time, before preparing the next medication or solution.5 (V)

5. Do not dilute or reconstitute IV push medications by drawing up the contents into a commercially available, prefilled flush syringe of 0.9% sodium chloride (USP).5,6 (V)

6. Do not withdraw IV push medications from commercially available, cartridge-type syringes into another syringe for administration.5 (V)

D. Do not use IV solutions in containers intended for infusion, including minibags, as common-source containers (multiple-dose product) to dilute or reconstitute medications for 1 or more patients in clinical care areas (see Standard 40, Flushing and Locking). (V)5-7

E. Use safe injection practices:
1. Use a new needle and syringe for every injection.6-8 (III)

2. Discard a single-dose vial after a single entry.5-8(V)

3. Dedicate a multidose vial for a single patient.5-8(V)

a. Use a multidose vial up to a maximum of 28 days of opening or puncture (except for vaccines or when original manufacturers expiration date is shorter) or when the manufacturers expiration date is reached if it is not opened in a direct patient care area or a shorter period.1-3,6-8 (V, Regulatory)

b. Label a multidose vial with the beyond-use date (BUD) and store the vial according to the manufacturers recommendations. Discard if the vial lacks a BUD, the sterility is compromised or questionable, and after the BUD has been met.1-3,6 (V, Regulatory)

F. Use a filter needle or filter straw to withdraw medication from an ampoule, and discard any leftover medication.1-3,5,6 (V, Regulatory)

G. Disinfect the vial septum before each entry and the neck of a glass ampoule prior to breaking the ampoule, and allow the disinfectant to dry prior to entry.5,6 (V)

H. Do not add medications to infusing containers of IV solutions (refer to Standard 57, Parenteral Medication and Solution Administration).

Hope this helps somewhat.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Vascular Access Consultant
E: tim.spencer68@icloud.com
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)
http://orcid.org/0000-0002-3128-2034

> On Jan 24, 2017, at 10:43 PM, Cate Coffey wrote:
>
> Hi everyone,
> Just wanting your thoughts, advice and experience regarding:
> Water for Injection ampules which attach directly to syringe V Water for Injection ampules that do not attach and require drawing up needle?
> Is one better than the other in terms of best practice or is it personal preference?
> thanks
> Cate Coffey | Clinical Nurse Consultant
> Infection Prevention and Control Unit | Central Australia Health Service
> Northern Territory Government
> Alice Springs Hopsital, Gap Rd, Alice Springs
> GPO Box 2234, Suburb, NT Postcode
> p … 08 89517737
> e … cate.coffey@nt.gov.au http://www.nt.gov.au/health
>
> Our Vision: Better health outcomes for all Central Australians
> Our Values: Community at the Centre | Equity and Integrity | We are Accountable | We are Relevant Today and Ready for Tomorrow | We are Committed to High Quality Care | We Value our Partnerships
>
> Central Australia Health Service is a Smoke Free Workplace
>
>
> The information in this e-mail is intended solely for the addressee named. It may contain legally privileged or confidential information that is subject to copyright. If you are not the intended recipient you must not use, disclose copy or distribute this communication. If you have received this message in error, please delete the e-mail and notify the sender. No representation is made that this e-mail is free of viruses. Virus scanning is recommended and is the responsibility of the recipient.
>
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
> The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
>
> Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
>
> Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
>
> To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
>

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

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