Epidurals and filters

[sublimaze]

Question for everyone: We are having a shortage of filter needles at some of our facilities (“cost issue”, go figure), and I remember my paranoid attendings during residency demand that we use a filter straw/needle and then inject meds through the in-line filter.

Do you all routinely use filter needles for bolused medications if your epidural tubing has an-line filter (the 0.2 micron filter is the one we typically have at most hospitals)? If you use the filter, there shouldn’t be any need for the filter needle then, right?

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[nimbus]

I’ve never used the filter needle even though they come in the kits.

 

[GassYous]

I use the filter needle sometimes because it's there but I don't care much about it. I don't think it's an issue unless you're seeing glass shards.

 

[Propofool123]

I have never used it.

 

[Greenbayslacker]

No need if you have a 0.2 µm filter in-line

 

[ethilo]

I draw up all meds from glass ampules with filter needles. I draw up all meds from vials with a blunt fill needle without filter. I don't think a filter is otherwise necessary with epidurals, even the infusion tubing. Not sure what it would be there to catch, none of the needs we give should sediment out, glass would be the only other thing but that's why I use filter needles with ampules.

 

[TheLoneWolf]

Kits had no filter needles in residency. Glass ampules. No issues. Used in line filter each time.

 

[abolt18]

Attending at my institution put a high speed macro camera on a bunch of ampules when breaking them and every time they had miniscule glass shards flying off and into the solution. Convinced me to use the filter needle 100% of the time that I draw anything up from a glass ampule.

 

[epidural man]

This may seem crazy but I’ve seen patients with very sharp stables left inside their body! I’ve seen other patients with large bolts and sharp wires left inside bones and stuff! It’s crazy!

And yet, they all do fine with these foreign sharp objects.

I doubt a very small piece of shard would do much sitting in the epidural space.

I could be wrong, but if so, I’d like someone to prove it. Literature to support your proof would be nice. I’d take case reports and low quality data.

 

[DrOwnage]

Now we will soon realize upon further analysis the glass shards injected into the epidural space cause autism. Dear baby jesus why...

 

[Tramadeezy]

Pain docs do a billion epidurals a day, none use a filter.

 

[deleted162650]

Pain docs do a billion epidurals a day, none use a filter.

They also don’t use break top glass vials. That’s the only time I bother with the filter.

 

[AdmiralChz]

I had no idea the purple needle was filtered, I use it as it’s the only one long and large enough to draw up the solution quickly. We don’t have filter straws in our kits.

Also no “loose” filter needles so it’s a blunt to draw up out of an ampule for us.

 

[Tramadeezy]

They also don’t use break top glass vials. That’s the only time I bother with the filter.

Our procedure kit has glass top vials for both lidocaine and normal saline. Use both in epidural mixture and NS in LOR.

 

[deleted162650]

Our procedure kit has glass top vials for both lidocaine and normal saline. Use both in epidural mixture and NS in LOR.

And all your patients have chronic back pain.

Coincidence?

 

[Tramadeezy]

And all your patients have chronic back pain.

Coincidence?

Yes, coincidence.