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This is an example of a cored piece of rubber inside of a propofol bottle. You can see a black speck inside the bottle.
I started becoming aware of this because during a recent procedure, after I had obtained adequate dye spread I could not inject the actual steroid because of sudden significant resistance. I assumed it was either a tight space or perhaps there was a slight change in needle position such that I was up against bone so I made the usual subtle readjustments but nothing was working. I simply could not push the medication at all.
I eventually withdrew the needle and inspected it finding a small piece of rubber had gotten stuck in the proximal hub of the needle that was blocking any fluid from getting through. I placed a new needle and everything was fine but it got me paranoid from that point forward.
I therefore started noticing more and more these similarly sized cored fragments within the injectate syringe from time to time. I never really noticed them before but perhaps it’s because I’m now specifically looking for them due to the above incident.
I just don’t feel right knowingly injecting these rubber fragments into the epidural space (if they are even able to make it all the way through through a 22 gauge needle without getting stuck in the first place). I’m pretty sure for those who use 25s they just won’t get through but may clog and create the frustrating situation I described earlier.
I just pay attention and inspect each syringe for such fragments.
It seems that though this has been a thing since their first paper in 2013, the APSF seems to be recently getting more and more notifications of this happening, which is why they published their recent article in March of 2025. Perhaps the increased frequency is due to some change in the manufacturing process of the vials which weakens the rubber and makes it more prone to shearing but who knows. I’d say just pay attention and take a quick look at what you or your nurse has drawn up for you as the fragments are somewhat obvious.
Just wanted to share my experience if it’s at all helpful.