COMPLETED RESEARCH: PRACTICE MANAGEMENT
Abstract #PM04

The Incidence of Coring Between the Traditional Syringe and Needle Compounding Technique and Closed-System Transfer Devices

JHOP - March 2021 Vol 11 Special Feature - HOPA Abstracts, Infusion Issues

Presenter: Kathryn French, BS, PharmD, MBA, Pharmacy Resident, Canton Potsdam Hospital

Co-Authors: Delaney Frears, PharmD Candidate, Albany College of Pharmacy and Health Sciences; Sahil Kamboj, PharmD, Albany College of Pharmacy; Regina Scott, PharmD, BCPS, Canton Potsdam Hospital; Ryan Titus, PharmD, BCPS, BCOP, Canton Potsdam Hospital

Background: Closed-system transfer devices (CSTDs) are used to transfer medication from one reservoir to another, while reducing the risk of hazardous drug exposure to the person mixing and administering. Coring is the production of rubber fragments that occur during manipulations within the intravenous drug compounding process. These fragments may be drawn up with the medication and injected into patients.

Objective: To compare the incidence of coring between CSTDs (PhaSeal and Equashield) and the traditional technique of intravenous drug preparation.

Methods: The institutional review board approved this case-control, independent group study and request for exclusion of informed consent was granted. Over the course of 9 months, pharmacists and pharmacy technicians working in the oncology infusion pharmacy closely identified and recorded the occurrence of coring with PhaSeal and Equashield during hazardous drug mixing. Coring was also monitored when using the traditional needle and syringe technique for nonhazardous drug preparation. All cores were filtered before admixture addition. Statistical significance was analyzed via the chi-squared test and association was determined by risk ratio (RR). The absolute risk reduction and numbers needed to harm were also calculated.

Results: Coring occurred in 3 of 625 (0.48%) vials with traditional needle and syringe technique, 110 of 1705 (6.45%) vials with PhaSeal, and 42 of 1760 (2.39%) vials with Equashield. The traditional syringe and needle compounding technique resulted in statistically significant decrease in coring compared with Equashield (P = .003; RR = 0.201; 95% confidence interval [CI], 0.063-0.647) or PhaSeal devices (P <.0001; RR = 0.074; 95% CI, 0.024-0.233). Equashield resulted in less coring compared with PhaSeal (P <.0001; RR = 0.37; 95% CI, 0.261-0.524). The absolute risk reduction was 4%, and the number needed to harm was 25.

Conclusion: The risk of cores injected into patients include thromboembolisms and organ damage.1 This study confirmed the increased occurrence of coring when using CSTDs.1 In addition, it demonstrated differences in coring incidences between CSTDs, as well as the need for continual education of pharmacy and nursing staff regarding the identification of cores and resulting filtration requirements.

  1. Wani T, Wadhwa A, Tobias JD. The incidence of coring with blunt versus sharp needles. J Clin Anesth. 2014;26:152-154.
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