Needles, Syringes & Safe Disposal

Dory Glaser-Watson RN, BScN, PNC(C), PANC(C), CLNC Education Coordinator Department of Surgery

June 2014

Objectives

Identify the types and sizes of needles Identify the uses for needles versus the using needle-less system Describe what are “safety engineered devices” Identify the use for the blunt needle (filtered and non filtered) Differentiate the types and sizes of syringes (leur lock vs slip tip) Demonstrate aseptic technique to open needle, non-needle and syringe

packaging Demonstrate aseptic technique to connect needle or non-needle and

syringe Demonstrate the correct aseptic technique to withdraw fluid from a vial

or glass ampoule Demonstrate correct technique to inject fluid Demonstrate correct mapping technique for administering an IM

injection Demonstrate correct mapping technique for administering a SC

injection Demonstrate correct disposal of sharps and syringes.

Safety Engineered Devices

A device that has a built in sharps injury protection mechanism such as an attached sheath covering the needle or scalpel after use or needles that retract after use.

Other types of safety devices include blunt needles or needle-less systems for access

Needles versus Needle-less System

When do needles and syringes get used? Skin Injection – IM, SC, Intra-dermal, hypodermoclysis, IV

insertion Reconstitution – mixing medications, transferring medications to

IV bags, IV push medications & fluids Syringe only – flushing catheters Needless System – connecting IV lines, sample collection from

arterial lines or venous catheters (central line port cap), irrigation and flushing, injecting medication / saline into IV tubing port with plastic cannula, withdrawing fluid / blood from venous / arterial access device via interlink cap / non-needle system from port

Needle Colour Codes

2 Styles of Safety Engineered Devices in AHS

Eclipse Available in small needle

lengths (< 1 inch) & longer needle length (1-1 ½ inch) as well as sizes from 30g to 18g.

Available in device used with slip tip syringes in needles 25-30 g. This has a metal strip seen at the hub.

SafetyGlide Available in needle sizes

from 30 g to 18 g. Not available in small needle

lengths < 1inch. Used in Insulin, TB, & Allergy

style needles. This system has a slightly different closure but is still called SafetyGlide.

Red Blunt Fill Needle (with or without filter)

Never Inserted into patient Never inserted into IV tubing (will destroy the membrane of the

needle-less tubing system). Withdraws from multi or single dose vial or ampoule Puncture stopper of vial at 90º angle to minimize risk of catching

internal wall of vial stopped. Remember, to insert equal volume of air to amount being removed from vial.

May be used to add medication to IV bag or minibag Discarded into sharps container Filtered Needles – use when withdrawing from glass ampoule

Withdrawing from Vial or Ampoule

Twinpak

All in one design

Activation of Safety Cover

Safety Glide

Eclypse

Syringes

Leur Lok Has a secure connection

where the tip is threaded for a locking fit and is compatible with needles, catheters and other devices

Available in 1, 3, 5, 10, 20 & 60 cc sizes

Slip Tip Has no locking connection Available in 1, 3, 5, 10, 20 &

60 cc sizes

Safety Lock Syringes

Locking device on syringe to cover needle completely. Needle retracts after use into a protective cover.

Syringes

TB & Insulin Syringes do differ

Preparing to Give an Injection

Know anatomy of site Avoid major blood vessels Avoid major nerves Awareness of landmarking of sites essential Considerations needed for size and age of patient

Average weight – you can reach SC tissue by using a ½” needle and inserting at a 90º angle

Thin – use a 5/8” needle and insert it at a 45º angle Elderly patients – consider using a shorter needle for IM

injections Select needle of sufficient length to reach targeted tissue (IM or

SC), depending upon size of patient Administer volumes appropriate to the target muscle

Injection Routes

Intramuscular (IM) – an injection into the muscle tissue (< 3mLs). Larger volumes require larger muscle (vas lat) while smaller volumes (up to 1 mL) can be injected into deltoid).

Subcutaneous (SC) – an injection into the fatty layer which lies beneath the dermis (≤ 0.5 – 1 mL). Less blood supply than of muscle tissue.

Intra-dermal (ID) – an injection into the dermis (0.1 mL). Used mostly to determine patient’s sensitivitiy (allergy testing, TB)

Injection Sites

Rotate sites frequently

IM Injections – Ventrogluteal Site

Landmarking

IM Injections - Deltoid

Landmarking

IM Injections – Vastus Lateralis

Landmarking

Standard Injection Procedure

Pediatric Considerations

Children can be very anxious or fearful of needles Assistance with proper positioning and holding of the child is necessary Distraction, such as blowing bubbles and pressure at the injection site

before giving the injection can help alleviate the child’s anxiety Children < 12 months of age – use the vastus lateralis muscle with a 3

mL syringe / 25 gauge / 1inch needle. Insert the needle at a 90º into the vastus lateralis. This site can be used for children older than 12 months of age with inadequate deltoid muscle mass.

Children > 12 months of age – use of deltoid (unless decreased muscle mass) with a 3 mL syringe / 25 gauge / 5/8 – 1 inch needle depending on the present muscle mass. Insert the needle at a 90º angle at the mid-portion of the deltoid.

Immediate disposal of syringe / needle into sharps container

Proper Positioning and Stabilization of Vastus Lateralis Muscle Children receiving a vastus lateralis site injection should be

stabilized in either of the following positions:

0-12 months of age

Positioning

Older child positioning

Prefilled Normal Saline Syringes

Designed for flushing vascular access devices PosiFlush XS saline filled syringes are terminally sterilized

following filling, labeling and packaging. Able to place on sterile field

Latex and preservative free Available in 3 mL, 5 mL, & 10 mL volume with leur lok Pre-filled saline syringes are NOT to be used for medication

administration as per the Institute for Safe Medication Practices Canada (ISMP) Syringe may not be correctly labeled once medication is

added Volumes may not be precise

Single use only device. DO NOT REUSE Dispose of unused solution One syringe / one patient only

Syringes & PSI

1 PSI (pounds per square inch) = 50 mmHg pressure Example: when a BP cuff is inflated to 200 mmHg pressure = 4 PSI A force of 3.5 PSI is required to activate a syringe plunger on most

small, prefilled syringes, so when a 3.5 PSI is applied to a 3 mL syringe a little over 29 PSI is generated as compared to a pressure of approximately 11 PSI when the same force is applied to a plunger of a 10 mL syringe.

Maintaining Sterility When Opening Packaging Maintaining sterility of contents when opening packages of

syringes and needles Quick observation of packaging for no tears/punctures or

water / fluid saturation that would render contents not sterile Notice of expiry date

Maintaining sterility of needles and syringes when connecting together Do not lay contents on counter once opened before

assembling needle to syringe

Correct Practice

Peel back the outer cover, ensuring not to contaminate the end of the syringe or needle.

Unacceptable Practice to Open Packaging

Do not “crack” open the packaging to retrieve contents

Contamination Risk

Do not lay opened contents on counter before assembling together as contaminates connecting areas on both the syringe and needle

Safe Disposal

Sharps Containers All needles & attached syringes Glass ampoules Blunt filled needles 5 Gallon Biohazard Pails Narcotics – squirt unused portion into pail (may be rendered

unusable). Do not drain down sink!

General Waste Empty plastic vials Empty syringes (no needle attached)

Resources

AHS Insite – video on giving IM Injections (Insite → Our Teams / Departments → Health Professions Strategy & Practice → Resources → Clinical Learning → IM Injection Video)

AHS Insite – Safety Engineered Devices - http://insite.albertahealthservices.ca/1653.asp

AHS External Web – Safety Engineered Devices - http://www.albertahealthservices.ca/1981.asp

BD Safety Engineered Devices - http://www.bd.com/ca/safety/products/injection/syringes_needles/

Alberta Occupational Health & Safety Legislation http://www.bd.com/ca/safety/regulations/alberta.asp

ISMP Canada (2012) ALERT: Errors with Prefilled Saline Syringes When Used to Reconstitute or Dilute Medications retrieved from

http://www.ismpcanada.org/download/safetyBulletins/2012/ISMPCSB2012-10_ALERT_Errors_with_Prefilled_Saline_Syringes.pdf