Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Coring: An Old Nemesis Has Resurfaced
Description
The transcript discusses the issue of "coring" that arises when using an 18-gauge needle to access vials of injectable medications, leading to the creation of rubber cores that can contaminate the solution. This contamination can be particularly hazardous in fields like anesthesiology, where it has been linked to serious complications. The speaker indicates that coring is also a relevant concern in dermatology, especially when reconstituting products like botulinum toxin and fillers. They emphasize that when using larger needles, inserting them at an angle rather than straight down can help reduce the occurrence of coring. The discussion transitions to the complications that can arise from filler injections, particularly concerning chronic edema in the orbital area due to blocking lymphatic drainage. The speaker recounts cases of patients suffering from persistent swelling following injections and discusses the application of hyaluronidase to correct issues related to hyaluronic acid fillers. Additionally, the importance of securely attaching needles to syringes is highlighted to prevent accidents, particularly around the delicate eye area. This implies a need for clinicians to be vigilant and cautious in their technique to avoid complications and ensure the best outcomes for patients.
View moreConclusions
- Coring occurs when a needle is inserted into a rubber stopper, leading to fragments being drawn into syringes and potentially injected into patients.
- Coring has been recognized as a serious risk in both anesthesia and dermatology, particularly with injectable medications.
- To prevent coring, it is advisable to insert needles at a 30° angle rather than straight down.
- Coring can commonly lead to complications with injectables, including the introduction of rubber fragments into patient treatments.
- Injecting with smaller needles such as 30 gauge may reduce the risk of drawing in coring particles, but it does not eliminate the possibility of rubber fragments.
- Careful technique in needle insertion and handling is crucial to prevent adverse effects from coring.
- Chronic complications, such as persistent eyelid edema, can occur from repeated filler injections in sensitive areas due to lymphatic blockage and fibrosis.
- In cases of overcorrection with fillers, hyaluronidase can be used effectively to manage excess hyaluronic acid.
- The study emphasizes the importance of thorough communication and patient care in managing dissatisfaction and complications that arise from cosmetic procedures.
- T. Wani, et. al. The incidence of coring with blunt versus sharp needles. Journal of Clinical Anesthesia (2014) 26, 152-154.
- Campagna R, et al. Occurrence of coring after needle insertion through a rubber stopper: study with prednisolone acetate. Eur Radiol (2013) 23:424-427.
- Honrado, C. et al. Facial Embryology and Anatomy in Master Techniques in Facial Rejuvenation. 2007. Anatomy and Botulinum Toxin Injections: E2E Medical Publishing/ Master Collection 1.
- Griepentrog, G. et al. Periorbital Edema Following Hyaluronic Acid Gel Injection: A Retrospective Review. AJCS. Volume 28, Number 4 2011.