Special ArticleThe incidence of coring with blunt versus sharp needles
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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