Filtering has become a sticky topic in our facility. Currently we have 0.22 micron and 80 micron filters as our only inventory items. This of course does not meet the needs for all meds that may require filtering. I am interested in whether there are facilities that filter all ffluids and what size filter is used. Also interested in what size filters you currently stock. if you slesctively filter meds for precipitate. Why is it that we use a 0.22 micron filter for TPN as opposed to a slightly larger filter? I thought this was for precipitate and wondered if it could be a little bigger to accomodate other meds a well. instead of having several different filter sizes for nurses to select.
There is a complete derscription of filters in my chapter on Equipment in the INS textbook. I can't imagine what you would use an 80 micron filter for, never have even heard of one that size. 0.22 micron is for filtering out all particulate matter, air and most microorganisms. Many years ago that was used for all filuids and meds but that practice has gone away since CDC said filtering is not a means of infection precention. It is recognized as a means to reduce phlebitis from that particulate. Check with your pharmacy to see what, if any, filtration is done during their compounding. They may be using a 5 micron filter to remove gross particulates.
For PN, a 0.22 micron is use for carbo and protein mixture. If lipds are piggybacked that should be below the filter as lipds cannot go thru this small filter. If you are using 3-in1 PN, a 1.2 micron filter should be used for the entire solution.
Standard blood filters are minimum of 170-180 microns.
I have always thought we paid more attention to filtration of fluids we put into our cars much more than fluids we put into humans. There is good evidence from Germany that filtration reduces inflammatory response in the lungs, decreasing granulomas, etc. in children with SARS.
Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
There is a really good webinar about this on the INS Knowledge Center website: Patient Safety and Infusion Management, Rethinking the role of Filtration.
PN not containing lipids must be filtered with a 0.22 micro filter to ensure no Calcium Phosphate precipitate. Lipids need a 1.2 micron filter due to the size of the molecules.
Currently at our hospital we have one unit that readily uses 0.22 Micron filters for all CVC's and PIV's (this is our Respirology Unit). I was asking the nurses on this unit to as why they always use filters and the reply was generally 'that's just how we've always done it'. However, we (the IV Team) were having a discussion regarding this the other day, and noted that we generally have a very low incidence of CLABSI, phlebitis and occlusions on this unit, leading us to wonder if filtration has anything to do with this. I'm hoping to apply for some research funds and see if I can trial another unit to see if there is any further decreases in complications whilst using an inline filter.
Lynn: Do you think the INS will be changing their stance on the issue in the next revision of the Standards?
Sorry I can't really say what the next edition of the standards will or will not include because it is not finalized yet. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861