Special Article
The incidence of coring with blunt versus sharp needles

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Abstract

With the advent of safety needles to prevent inadvertent needle sticks in the operating room (OR), a potentially new issue has arisen. These needles may result in coring, or the shaving off of fragments of the rubber stopper, when the needle is pierced through the rubber stopper of the medication vial. These fragments may be left in the vial and then drawn up with the medication and possibly injected into patients. The current study prospectively evaluated the incidence of coring when blunt and sharp needles were used to pierce rubber topped vials. We also evaluated the incidence of coring in empty medication vials with rubber tops. The rubber caps were then pierced with either an18-gauge sharp hypodermic needle or a blunt plastic (safety) needle. Coring occurred in 102 of 250 (40.8%) vials when a blunt needle was used versus 9 of 215 (4.2%) vials with a sharp needle (P < 0.0001). A significant incidence of coring was demonstrated when a blunt plastic safety needle was used. This situation is potentially a patient safety hazard and methods to eliminate this problem are needed.

Introduction

Safety concerns focus not only on patients, but also healthcare providers. One such concern includes means to limit the exposure of healthcare providers to inadvertent needle sticks. The issue of needle stick injuries remains a major concern for anesthesia care providers. To some extent, the potential for such problems has been addressed by introducing and increasing the use of blunt tip needles [1], [2], [3]. The blunt needle has virtually replaced sharp needles in many operating rooms (ORs) and anesthesia areas for accessing vials and preparing perioperative medications. However, the use of these needles may increase the potential for “coring”, or a phenomenon in which fragments of the rubber stopper are shaved off when a needle is stuck into the rubber stopper of the medication vial. These fragments may be left in the vial and then drawn up with the medication and potentially injected into patients. The implications of this small particle of rubber are unknown [4], [5], [6]. We hypothesized that in the OR coring happens on a regular basis. The current study prospectively evaluated the incidence of coring when blunt and sharp needles are used to enter rubber topped vials.

Section snippets

Materials and methods

A total of 465 empty medication vials with rubber tops were collected from the ORs of the University of Louisville Hospital. The vials were rinsed with saline and the rubber caps were replaced. Anesthesia providers (ie, certified registered nurse anesthetists or anesthesiology residents) were randomized via sealed envelope assignment to use an 18-gauge sharp hypodermic needle or a blunt plastic (safety) needle to pierce the rubber caps from 10 vials. A blinded investigator collected these

Results

We found that coring occurred in 102 of 250 (40.8%) vials when a blunt needle was used as compared with 9 of 215 (4.2%) vials with a sharp needle (P < 0.0001). The incidence of coring with blunt and sharp needles in various medication vials is listed in Table 1, Table 2. Among the various medication vials, the highest incidence of coring was noted in propofol, cefazolin, and neostigmine vials with an incidence of 58%, 86%, and 63.6% respectively.

Discussion

The current study confirms the hypothesis that coring occurs in a significant percentage of cases when a blunt needle is used. The clinical implication is the possibility of the core being loaded into the syringe and injected into the patient with its potential for deleterious physiological effects. Coring has been previously evaluated when using vials of prednisolone acetate [7]. The medication was drawn from the vial using an 18-gauge cutting beveled needle. The investigators noted an

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