Letters to the Editor: Letters & Announcements
Drs. Riess and Strong1 report a case of coring after using a blunt fill needle. Their experience contrasts with that at my institution. Following multiple recurring reports of coring, we changed to the18-gauge Blunt Fill Needle (BD, Franklin Lanes, NJ) and our propofol supplier, and our problem of coring seems to have vanished. We use a metal blunt fill needle as opposed to their plastic cannula. In addition, we use generic propofol with a softer stopper. The differences in our experiences may be due to different needles and/or stoppers. Of interest, their corings sank in the propofol whereas our corings floated, thus making it easier to detect the coring.
The technique of needle insertion described in my letter is accepted in the pharmacy community as a technique that reduces the risk of coring.2 Regardless of which needle is used, the application of this technique should reduce the risk of coring. In addition, the blunt fill needles do not easily break skin and thus are likely to reduce the chance of penetrating needle stick injuries.
There are other strategies that can be used to prevent the injection of corings. First, one can aspirate medications via a needle with a filter such as those found in various spinal anesthetic kits. Alternatively, one can avoid piercing a stopper altogether. One can remove the stopper from a vial with a pliers-like device (e.g., Kebby Decapper, Kebby Industries, Inc., Rockford, IL) as we do for latex allergic patients. Alternatively, the pharmaceutical manufacturers can provide us with single use medication vials where: one just pulls off the entire top (e.g., various local anesthetics from Astra Zeneca LP, Wilmington, DE); or syringes attach directly to the vials (e.g., various local anesthetics from Astra Zeneca LP). Lastly, manufacturers could provide stoppers that would always float thus making it easier to detect a coring and less likely to be injected via a vertically oriented syringe.
Jonathan V. Roth, MD
Associate Professor of Anesthesiology
Thomas Jefferson School of Medicine
Department of Anesthesiology
Albert Einstein Medical Center
1. Riess ML, Strong T. Near-embolization of a rubber core from a propofol vial. Anesth Analg 2008;106:1020–1
2. Roth JV. How to enter a medication vial without coring. Anesth Analg 2007;104: 1615