Filter needles with glass ampoules in ESI

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nerve zapper

PGY-4 PM&R
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Current fellow here. Our epidural kits contain glass ampoules for saline and lido.

Do you use filter needles for meds drawn from glass ampoules to be used for an ESI?

One of my attendings dumps the saline into the tray and draws it into the LOR syringe wo a filter needle.

Another makes sure to break the ampoule top over the sharps container and then uses a filter needle to draw up.
 
Dude, not as if the fellow can avoid them.Yes, filter straw or filter needle. I’ve occasionally had to use the glass ampules due to drug shortages. Also, hold the top with a gauze when you snap it off. I’ve seen some nasty little pieces sticking up occasionally.
Good advice. I have cut my thumb on a glass top that shattered rather than broke cleanly. I always use gauze now.
 
Dude, not as if the fellow can avoid them.Yes, filter straw or filter needle. I’ve occasionally had to use the glass ampules due to drug shortages. Also, hold the top with a gauze when you snap it off. I’ve seen some nasty little pieces sticking up occasionally.
This!
 
Dude, not as if the fellow can avoid them.Yes, filter straw or filter needle. I’ve occasionally had to use the glass ampules due to drug shortages. Also, hold the top with a gauze when you snap it off. I’ve seen some nasty little pieces sticking up occasionally.
Haha. Thread is closed.
 
You don’t need gauze. Hold amp in left hand. Left thumb nail at the neck of the amp, that thumb nail facing superiorly. Right thumb nail abutting the left thumb nail facing inferiorly. Grab the top of the amp with pointer finger. Lever the top of the amp with that finger while raising your right hand up. Perfect every time.

Some amps have a dot indicating where the soft spot is. Very important not to force those except where indicated.
 
we started using a filter needle for our lido and saline that come in the plastic bottles with the rubber/plastic top that you have to poke through. I dont know if those are made differently now. in the last year, I started noticing small chunks of that top floating in the bottle or sucked up into my syringe. As a result, I have started using a filter needle even for that. If I had a glass container, would also use filter needle for sure.
 
we started using a filter needle for our lido and saline that come in the plastic bottles with the rubber/plastic top that you have to poke through. I dont know if those are made differently now. in the last year, I started noticing small chunks of that top floating in the bottle or sucked up into my syringe. As a result, I have started using a filter needle even for that. If I had a glass container, would also use filter needle for sure.
I've been noticing this more as well.
 
I’ve also noticed these cored rubber particles within the syringe. The Anesthsia Patient Safety Foundation has an article from 2013 and one from this year regarding best practices.

Here is a link to the 2025 article.

 
1) Graduate
2) Enter real life practice
3) Stop caring entirely about filter needles and microscopic amounts of glass left in tissue.
 
IMG_6464.jpeg


This is an example of a cored piece of rubber inside of a propofol bottle. You can see a black speck inside the bottle.

I started becoming aware of this because during a recent procedure, after I had obtained adequate dye spread I could not inject the actual steroid because of sudden significant resistance. I assumed it was either a tight space or perhaps there was a slight change in needle position such that I was up against bone so I made the usual subtle readjustments but nothing was working. I simply could not push the medication at all.

I eventually withdrew the needle and inspected it finding a small piece of rubber had gotten stuck in the proximal hub of the needle that was blocking any fluid from getting through. I placed a new needle and everything was fine but it got me paranoid from that point forward.

I therefore started noticing more and more these similarly sized cored fragments within the injectate syringe from time to time. I never really noticed them before but perhaps it’s because I’m now specifically looking for them due to the above incident.

I just don’t feel right knowingly injecting these rubber fragments into the epidural space (if they are even able to make it all the way through through a 22 gauge needle without getting stuck in the first place). I’m pretty sure for those who use 25s they just won’t get through but may clog and create the frustrating situation I described earlier.

I just pay attention and inspect each syringe for such fragments.

It seems that though this has been a thing since their first paper in 2013, the APSF seems to be recently getting more and more notifications of this happening, which is why they published their recent article in March of 2025. Perhaps the increased frequency is due to some change in the manufacturing process of the vials which weakens the rubber and makes it more prone to shearing but who knows. I’d say just pay attention and take a quick look at what you or your nurse has drawn up for you as the fragments are somewhat obvious.

Just wanted to share my experience if it’s at all helpful.
 
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This is an example of a cored piece of rubber inside of a propofol bottle. You can see a black speck inside the bottle.

I started becoming aware of this because during a recent procedure, after I had obtained adequate dye spread I could not inject the actual steroid because of sudden significant resistance. I assumed it was either a tight space or perhaps there was a slight change in needle position such that I was up against bone so I made the usual subtle readjustments but nothing was working. I simply could not push the medication at all.

I eventually withdrew the needle and inspected it finding a small piece of rubber had gotten stuck in the proximal hub of the needle that was blocking any fluid from getting through. I placed a new needle and everything was fine but it got me paranoid from that point forward.

I therefore started noticing more and more these similarly sized cored fragments within the injectate syringe from time to time. I never really noticed them before but perhaps it’s because I’m now specifically looking for them due to the above incident.

I just don’t feel right knowingly injecting these rubber fragments into the epidural space (if they are even able to make it all the way through through a 22 gauge needle without getting stuck in the first place). I’m pretty sure for those who use 25s they just won’t get through but may clog and create the frustrating situation I described earlier.

I just pay attention and inspect each syringe for such fragments.

It seems that though this has been a thing since their first paper in 2013, the APSF seems to be recently getting more and more notifications of this happening, which is why they published their recent article in March of 2025. Perhaps the increased frequency is due to some change in the manufacturing process of the vials which weakens the rubber and makes it more prone to shearing but who knows. I’d say just pay attention and take a quick look at what you or your nurse has drawn up for you as the fragments are somewhat obvious.

Just wanted to share my experience if it’s at all helpful.
The needles that come in our new kits seem to core stoppers more than the needles we used to use. I started having to actually watch the way I inserted the needle through the stopper.
 

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The rubber pieces have been in my syringes as far back as I can remember. They stay in the syringe the vast majority of the time. They aren’t fitting through a 25g needle.
 
but they may obstruct the 25-gauge needle and alter the procedure itself, not allowing you to inject medication.

technically, it is being bored out by an 18-gauge so shouldnt even fit through a 22 gauge, but given enough force, who knows?

to avoid harm, i put my right-hand index finger under the mark on the bottle. use your thumb on the top on the other side and gently snap off the top by twisting the wrist - dont put circumferential pressure on the top of the glass bottle.
 
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