QUESTION: Our recent OR director is...

QUESTION: Our recent OR director is concerned about in what way 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 not at any time done this at this facility. a certain of the nurses who have worked in other facilities report that they used to draw up medications from glass vials using filters, on the other hand 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 originate from? What is the rationale?

ANSWER: The American Society for Health scheme Pharmacists recommends filtering solutions drawn up from glass ampules to extract glass particles. (1) Opening a glass ampule bring forwards a spray of tiny glass particles. Many of these fractured minuscule glass particles can pierce the ampule and contaminate the satisfieds The size of the glass particles increases proportionally with the size of the vial. (23)

Animal studies have demonstrated that IV administration of glass particles is associated with pathological replications Glass particles were found in the pulmonary capillaries, livers, kidneys, piques and intestinal walls of animals studied. The research demonstrated that glass particles caused inflammatory replications thrombi, and foreign body granulomas. (23)

A investigation on glass particle contamination in glass ampules demonstrates that the mean glass particle regard in ampules after they were make opened was approximately 100.6 particles, ranging in size from 10 [micro]m by 10 mL to 1,000 [micro]m by 10 mL. Glass ampules with transparent metal etching produc significantly more glass particles. Aspiration of solutions from glass vials [i]or[/i] part of to the other an 18-g needle reduced the mean number of glass particles to 656 and decreased the maximum particle size to les than 400 [micro]m by 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 13 [+ or -] 03 and 12 [+ or -] 03 respectively. Particle size was decreased to les than 200 [micro]m. (3)

Data demonstrate that aspiration by the agency of 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 more [i]or[/i] less of our wrapped instrument places have small amounts of moisture upon the inside. Sometimes the wrapper still is to a high degree warm when we receive the wagers from the central processing department (CPD) a staff nurses think it is acceptable to use the put if the outside of the wrapper is thirsty I was taught that if an item is wet or damp, it is not sterile. After numerous discussions, we cannot appear to agree on the best approach. What does AORN recommend? If the wrapped instrument locate is only slightly damp upon the inside but the outside is dried is it acceptable to use the instruments?

ANSWER: A sterile, wrapped place with moisture or dampness upon the inside should be refuseed even if there is no evidence of wetness forward the outside. Moisture, whether onward the inside or the outside, causes a wicking result and provides access for microorganisms to enroll and contaminate the sterile settle The pack may have been wet onward the outside and dried before it was expanded Regardless of the location, wetness or dampness creates doubt about the sterility of the risk and it should be considered unsterile. (4)

Wrapped items that still are extremely warm should not be handled. All items remov from the sterilizer after the sterilizing proces should remain forward the sterilizer cart until they are dispassionateed adequately. Warm items should not be handled, touched, or mov to another cart until they have indifferented completely. At the end of a sterilization period there still is some steam vapor in the packages. irascible packs act as wicks when touched, absorbing moisture and bacteria from hands. Transferring passionate items to a cold cart also causes condensation to bring out which may result in a wet, contaminated pack. During cooling, the sterilizer cart should be left in the sterilizer with the door expand or placed in a low-traffic area until it is completely indifferent (4-6)

QUESTION: about of our instrument sets are extremely heavy. We are disturbed that someone will injure his or her back or that the stakes will not be sterile as a rise 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 settle should be based on the number of instruments, total weight, and density. settles should be of a size that easily and safely can be lifted using fit body mechanics, without endangering the safety of employee or compromising the sterility or integrity of the sterile wrap. If puts are too heavy, they may be dropp or the sterile wrapping may be torn as settles are dragged across shelving, causing damage to the instruments and possible employee injury. If the weight of instrument settles is causing back injuries or a ne for resterilization, it may be in the best financial interest of a facility to assist and support staff members through reducing the size of the sets