Abstract
ObjectiveVial coring describes the occurrence of small rubber particles, which are formed by needles when perforating vial stoppers. These particles may be aspirated along with the drug. Unconscious injection of rubber particles may increase the risks associated with intra-articular injections. This study aimed to analyze the frequency of this phenomenon and possibilities to avoid its occurrence. Method800 vials of 2 mL, filled with sodium chloride, were divided into 4 groups (n = 200 each). Aspiration through the rubber stopper was performed with a 18-Gauge needle and the fluid was ejected onto a 10 μm filter paper through a 18-Gauge needle (group one) and a 23-Gauge needle (group two). In group three a 23-Gauge needle was used for aspiration and ejection. In group four, aspiration was performed using 18-Gauge needles with implemented 5 μm filters. Subsequently, a microscopic analysis of the filter papers was performed. ResultsIn none of the 800 specimen, a rubber particle was detected by naked eye. Microscopically, 20 (10%) rubber particles were detected in group one, 21 (11%) in group two and 65 (33%) in group three. In group four, no particles were visualized. ConclusionThis study shows the occurrence of rubber particles in 10–33% of the cases, when standard needles are used for the aspiration of drugs. We therefore recommend using industrially prefilled syringes, filter needles or removing the rubber stopper before withdrawing drugs from vials for intra-articular injections.
Highlights
Intra-articular injections for therapeutic and diagnostic reasons with local anesthetics and corticosteroids represent an established clinical practice, commonly used in the symptomatic treatment of inflammatory rheumatic diseases and osteoarthritis [1–8].Complications of intra-articular injections include local hematoma, infection, hypopigmentation, subcutaneous fat and muscle atrophy and osteonecrosis [9,10], the most devastating being septic arthritis
Vial coring describes the occurrence of small rubber particles, which are formed by needles when perforating vial stoppers
Embolisms after intravenous drug application was found to be related to vial coring, indicating that intra-articular injections are at risk for vial coring associated complications including septic arthritis [11,16–19]
Summary
Intra-articular injections for therapeutic and diagnostic reasons with local anesthetics and corticosteroids represent an established clinical practice, commonly used in the symptomatic treatment of inflammatory rheumatic diseases and osteoarthritis [1–8].Complications of intra-articular injections include local hematoma, infection, hypopigmentation, subcutaneous fat and muscle atrophy and osteonecrosis [9,10], the most devastating being septic arthritis. A complication that has not been reported frequently and the clinical effects of which are not clear, is the inadvertent injection of small rubber particles into the joint. The occurrence of such a foreign body in the injection fluid is called vial coring and is reported with an incidence between 4 and 40% in in-vitro studies depending on the applied needle and puncture angle [11–14]. Vial coring describes the occurrence of small rubber particles, which are formed by needles when perforating vial stoppers These particles may be aspirated from the vial into the syringe along with the drug, and could be injected into joints unconsciously [15]. A foreign body reaction could promote rapid destructive osteoarthritis [20]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call