فهرست نشریات علمی دسترسی آزاد ایران

Dear Editor Intravenous injection through superficial veins is one of the most common and effective methods for drug administration. Most pharmaceutical agents are packaged in glass ampoules due to their advantages, including ease of use and the ability to maintain sterility, which facilitates drug handling in pharmacy settings.[1,2] A study indicated that 66.8% of ampoules were contaminated with glass particulate matter. This research found that using a cotton ball to break the ampoule from the outside significantly reduced the incidence of glass particle contamination. In contrast, breaking the ampoule inward with a gauze pad resulted in a higher presence of glass particles. These findings suggest that the techniques employed by healthcare professionals in wrapping and breaking ampoules can significantly influence the level of glass particle contamination in intravenous preparations.[3]Challenges  When an ampoule is broken, particulate matter, including dirt and dust, may enter the medication, posing a considerable risk of glass particle contamination in patients. This issue can arise during both invasive and non-invasive procedures, potentially jeopardizing patient safety and leading to severe adverse outcomes.[1] Numerous studies have shown that following the breakage of the ampoule neck and subsequent aspiration of the pharmaceutical solution into a syringe, both microscopic and macroscopic glass particles can contaminate the syringe.[1,3-5] The presence of these particles in large and small blood vessels, as well as capillaries, can lead to various pathological conditions, including vascular rupture, inflammatory responses, and the formation of atheromatous plaques.[5] For instance, in patients undergoing percutaneous coronary intervention (PCI), it is crucial to rapidly administer various pharmacological agents via the femoral or brachial artery. The introduction of either large or small glass particles into injectable pharmaceuticals significantly increases the risk of vascular injury, including potential damage to coronary vessels.[6]Potential solutions  To reduce the risks associated with intravenous therapy, several evidence-based strategies can be implemented to minimize adverse outcomes. These include substituting traditional glass ampoules with alternative packaging options such as plastic containers or vials, using filter needles, employing filtered serum administration sets at the initiation or conclusion of infusion, and utilizing prefilled syringes.[3] Additionally, applying alcohol-soaked cotton and using alcohol spray are two further strategies that can help remove contaminants, reduce the risk of infection, and facilitate the breakage of the ampoule neck with minimal force and risk of damage.[7]A previously published study indicates that allowing a slight delay during the aspiration of pharmaceutical agents from ampoules can reduce the presence of larger particulate matter.[3] However, in high-demand settings such as emergency departments, where nurses have limited time, waiting for particle sedimentation before administration is often impractical. Conclusion  Given the current constraints in healthcare settings, implementing at least one of the recommended interventions, particularly the use of filter needles or filtered infusion sets, is crucial, especially for high-risk patients such as those with cardiovascular diseases, cerebrovascular disorders, malignancies, and critically ill neonates. However, under optimal clinical conditions, it is recommended to utilize both a filter needle and a filter set for all patients receiving intravenous therapy to ensure maximum safety and efficacy.