Isolated cases of systemic reactions to latex allergens have been reported and often associated with the use of multidose vials.
Microscopic rubber particles can contaminate the medication and upon systemic administration may cause latex allergy. A case of near-embolization of the rubber core from a propofol vial that lodged itself into the 24-gauge angiocath interrupting the propofol infusion and setting off the high-pressure pump alarm during a rigid bronchoscopy has been reported. 2 Aspiration of a cylinder shaped rubber core back into the syringe followed by introduction into a patient’s blood stream might seem an unlikely combination of events. 1 The cored fragments can be difficult to visualize because of their small size, the masking effect of the vial labels, or the medication opacity.Įxposure to the macro and microscopic rubber fragments has been linked to latex allergy as well as embolization into small vessels causing ischemia. Per one study, the incidence of coring was 29% with blunt plastic needles as opposed to only 4% with acutely beveled sharp steel needles. The frequency of such incidents seems to be rising as the use of blunt plastic tips increases. The issue of coring, the shearing off of a portion of the rubber stopper from a medication vial as it is pierced has been described in the past. Upon close inspection, a cored piece of rubber from the vial’s rubber stopper was identified (Figure). After the needle was withdrawn, a dark object was seen at the bottom of the propofol vial. An induction dose of propofol was drawn through a disposable syringe attached to a blunt plastic needle to pierce the rubber stopper. Such contamination has been linkedto latex sensitivity and fragment embolization.Ī 45-year-old female was being prepared for induction of general anesthesia for a total thyroidectomy. A cored piece of propofol rubber cap after the cap was pierced with a blunt tip plastic needle to draw the medication.
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