Rubber Coring: The Overlooked Medication Safety Issue That Every Healthcare Professional Should Understand

Every day, billions of injectable medications are prepared around the world.

Nurses draw antibiotics before administering them in the emergency department. Pharmacists prepare chemotherapy in sterile compounding rooms. Anesthesia providers fill syringes before surgery. Nuclear medicine technologists prepare radiopharmaceuticals. Clinics administer hormone replacement therapy, biologics, vaccines, and specialty medications.

The process is so routine that few healthcare professionals stop to ask an important question:

What happens to the rubber stopper every time a steel needle punctures a medication vial?

The answer may surprise you.

What Is Rubber Coring?

Rubber coring occurs when a needle removes a small fragment of rubber from the stopper of a medication vial during puncture.

Instead of cleanly separating the elastomer, the needle can cut or dislodge a microscopic piece of rubber.

That fragment may:

• Remain embedded in the stopper.
• Fall into the medication vial.
• Be aspirated into the syringe.
• Potentially be delivered during medication administration.

Although often microscopic, rubber particulate has been recognized and studied in the medical literature for decades.

Why Does Rubber Coring Matter?

Medication safety has traditionally focused on:

• Correct medication
• Correct patient
• Correct dose
• Correct route
• Correct timing

Far less attention has been given to what may inadvertently enter the syringe during medication preparation.

Every puncture of a rubber stopper represents a mechanical interaction between:

• Needle design
• Bevel geometry
• Rubber composition
• Insertion angle
• Needle gauge
• Puncture technique

These variables influence whether the stopper remains intact or whether particulate may be generated.

What Does the Research Show?

Multiple published studies have investigated rubber stopper coring and particulate generation.

Researchers have demonstrated that:

• Rubber coring can occur during puncture of medication vial stoppers.
• The incidence varies depending on the access device and puncture technique.
• Device geometry plays an important role.
• Certain vial-access cannula designs have demonstrated little or no observed coring under specific study conditions.

These findings highlight an important engineering principle:

The design of the vial-access device matters.

Why Traditional Workflow May Increase Opportunities

Conventional medication preparation frequently relies on steel needles to access medication vials.

Depending on the medication and clinical setting, practitioners may:

• Insert the needle.
• Withdraw medication.
• Reposition the needle.
• Rotate the bevel.
• Tilt the vial.
• Perform repeated punctures on multi-dose vials.

Each additional puncture creates another opportunity for interaction with the rubber stopper.

The Engineering Challenge

Interestingly, conventional hypodermic needles were designed primarily to penetrate human tissue.

Over time, healthcare adopted those same needles as the standard tool for medication withdrawal.

However, tissue penetration and medication preparation are two different engineering problems.

One is optimized for skin.

The other is optimized for rubber.

Could Syringe Design Reduce Coring?

Rather than asking healthcare professionals to modify their technique, another approach is to redesign the device itself.

This is one of the concepts behind the QD Syringe Platform.

Instead of relying on a separate steel draw needle, the QD Platform incorporates an integrated medication preparation cannula with a non-coring design objective.

The goal is to eliminate the separate steel draw needle used during medication preparation while simplifying workflow and reducing opportunities for rubber particulate generation.

Dedicated bench testing would be required to quantify coring performance compared with conventional devices, but the engineering objective is clear:

Design the medication preparation device specifically for medication preparation.

Beyond Coring: Additional Benefits of Rethinking Medication Preparation

A redesigned medication preparation platform may offer additional potential advantages, including:

• Reduced medication waste through low dead-space design.
• Elimination of separate draw needles.
• Simplified medication preparation workflow.
• Reduced sharps handling.
• Lower inventory requirements.
• Improved pharmacy efficiency.
• Better recovery of expensive injectable medications.

Although these represent separate engineering objectives, they all stem from the same central philosophy:

Optimize the syringe for medication preparation rather than asking clinicians to compensate for its limitations.

Why This Matters More Than Ever

Healthcare is entering an era of increasingly expensive injectable therapies.

Biologics, monoclonal antibodies, gene therapies, oncology medications, hormone replacement products, radiopharmaceuticals, and specialty injectables all require careful preparation.

As the value of every milliliter continues to rise, the importance of medication preparation devices also increases.

Questions once considered minor such as dead space, rubber coring, medication recovery, and workflow efficiency are becoming increasingly important for hospitals, pharmacies, and healthcare systems.

The Future of Medication Preparation

Rubber coring may not be the most widely discussed medication safety issue.

But it illustrates a much larger point.

Many of the devices used during medication preparation were developed decades ago for a healthcare system that looked very different from today's.

Perhaps the future of medication safety is not simply developing better medications.

Perhaps it also involves developing better tools to prepare them.

The QD Platform represents one vision of that future a modular medication preparation system designed to simplify workflow, reduce medication waste, support low dead-space delivery, and explore new approaches to vial access that may reduce opportunities for rubber coring while improving the overall medication preparation process.

As healthcare continues to evolve, even the smallest components of medication delivery deserve thoughtful innovation.