Overview - Nurses Changing Needles Between Drawing and Injecting Medications: Increasing or Decreasing?
Exhaustive research of the public domain indicates that there are no case studies, surveys, or analyses available which assess the increase or decrease of nurses changing needles between drawing and injection medications. Our composite research findings indicates that changing needles (or using single dose syringes) has been a consistent practice among US nurses since 2004, particularly for IM injections; however, the growing North American market for pre-filled syringes could indicate a decrease in the need (and therefore the practice) of needle changing. Another potential factor in the theoretical decrease in needle changing is the WHO's 2014 recommendation to replace injections with other delivery methods, whenever possible. Below you'll find our methodology and related findings.
We began by researching through medical publications over the past five years for case studies, reports, analyses, or surveys on needle-change practices, but our research of a dozen highly reputable publications did not generate any information on this topic whatsoever, even when the time frame was extended. We then researched governmental and NGO databases (CDC, WHO, etc), which yielded some support for the assumption that change needles or using single-dose syringes is considered a best practice globally. It did not, however, generate any information which directly answers your question, which may be because the authority to decide whether or not to change needles is inconsistent among individual nurses, clinics and hospitals
Broadening our sources generated the most direct evidence of the commonality of changing needles, but the information is both anecdotal and over a decade old, so it doesn't provide us with an accurate way to estimate the change in use over the past few years. Our research did not generate any information about change in volume of subQ or IM injections in the US in the past few years, although the WHO noted in 2014 that it is considered best practice to minimize injections in favor of other delivery methods, when applicable.
Nurse respondents in the US-based All Nurses nursing forum overwhelmingly indicate that they generally change their needles, especially for IM injections. The comment threads we researched were from 2004 - 2010; and while there were certainly outliers, the vast majority of nursing respondents commented that they always changed needles and that they were taught this as a best practice in school. In the thread specific to IM injection, 100% of respondents commented that they routinely change needles. This is clearly dated data, but is the most directly relevant information available; and indicates that in the first decade of the 21st century, changing needles was anecdotally considered to be a best practice, and was a common one.
CHANGING NEEDLE AS A STANDARD PRACTICE
Our broader research generated evidence that, similar to the US environment, changing needles is not a standard requirement in international Western medical practice, but it is sometimes required at an organizational level. While single dose syringes are referenced as a requirement in Canadian teaching texts, the text we researched also says: "If single use equipment is not available, use syringes and needles designed for steam sterilization." On the other hand, Our Lady's Children Hospital, in Crumlin, Ireland, requires needle changes: "Change needles after drawing up medication to ensure a clean needle for administration. This reduces irritation, pain and inadvertent administration of foreign particulate matter." This requirement was specific to IM injections.
Collectively, this information indicates that needle changing requirements are not globally consistent, which is commensurate with the inconsistency in requirements in the US clinical environment. These sources were included because they represent a significant portion of the limited information available specific to needle change practice or requirements, either nationally or internationally.
The market size for pre-filled syringes is growing significantly, both globally and specifically in North America. Although there is no information available that directly relates this increased market to a change in needle changing practices, it is reasonable to assume that this market growth could indicate an overall decrease in needle changes due to the lack of need or opportunity, especially if we assume that the percentage of forum respondents at All Nurses accurately represents a high incidence level of needle changing when pre-filled syringes are unavailable.
STUDIES AND COST CONCERNS
Our research discovered no recent studies or research directly applicable to needle techniques and patient pain, or to cost assessments of needle changing. We discovered one 2010 study specific to the intersection of needle technique and patient pain; and another 2010 study was cited in the Our Lady's Children's Hospital brief. However, our research of medical and scientific databases did not generate any more recent examples, for which reason we assume that it is not an area of significant study. While we found no hard evidence of cost concerns limiting needle changes, anecdotal evidence indicates that a small subset of the nurse respondent population either considered needle changes a waste of resources, or had worked for organizations who held that perspective.
Best practices and nurse anecdotal experience seem to indicate that changing needles is fairly common. However, multiple best practices and market situations could indicate a decrease in this frequency of practice due to the lack of need or opportunity: if nurses are following WHO recommendations for limiting injections, and given the increase of the pre-filled syringe market, it is reasonable to assume that needle changing practices may be on the decline.