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Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea
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Quantifying and Reducing Retained Botulinum Toxin Postinjection.

Ryan Solinsky1, Steven C Kirshblum2

  • 1Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA 02129.

PM & R : the Journal of Injury, Function, and Rehabilitation
|July 3, 2018
PubMed
Summary
This summary is machine-generated.

Significant amounts of botulinum toxin were wasted during spasticity injections. Implementing simple guidelines, like decapping vials, drastically reduced this waste, ensuring patients receive full prescribed doses.

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Area of Science:

  • Neurology
  • Pharmacology
  • Medical Quality Assurance

Background:

  • Retained botulinum toxin solution in vials and syringes after mixing and injections leads to underdosing patients.
  • Quantifying this retained toxin is crucial for optimizing treatment delivery.

Purpose of the Study:

  • To quantify the mean amount of retained botulinum toxin (onabotulinumtoxinA or incobotulinumtoxinA) in vials, syringes, and needles after spasticity injections.
  • To design and test interventions to minimize retained toxin volume.

Main Methods:

  • Prospective cohort quality assurance study in an outpatient spasticity program.
  • Nine physical medicine and rehabilitation physicians participated, performing spasticity injections.
  • Interventions included not inverting vials, favoring 2-mL dilutions, and decapping vials for complete withdrawal.

Main Results:

  • Phase 1: 5.5% (approx. 452 units) of botulinum toxin A was retained in 82 preintervention vials.
  • Syringe tips retained mean of 3.32 units (1-mL) and 1.44 units (3-mL).
  • Phase 2 interventions significantly reduced retained toxin: non-inverted vial withdrawal decreased waste by 32.8%, and decapping vials reduced it by 81.9% (to 0.42 units/vial).

Conclusions:

  • A clinically significant volume of botulinum toxin is retained post-injection, impacting patient dosage.
  • Implementing specific procedural guidelines effectively minimizes wasted botulinum toxin, improving treatment delivery.