Needle-free jet injection-induced small-droplet aerosol formation during intralesional bleomycin therapy

Liora Bik*, Albert Wolkerstorfer, Vazula Bekkers, Errol P. Prens, Merete Haedersdal, Daniel Bonn, Martijn B.A. van Doorn

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)
23 Downloads (Pure)


Objectives: Needle-free jet injectors are frequently used in dermatological practice. Injection-generated small-droplet aerosols could be harmful upon inhalation when chemotherapeutics, like bleomycin, are used. Here, we aim to explore jet injector-induced small-droplet aerosol formation of bleomycin in relation to air ventilation and to provide safety measures for clinical practice. Materials and Methods: With a professional particle sensor, we measured airborne aerosol particles (0.2–10.0 µm) after electronic pneumatic injection (EPI), spring-loaded jet injection (SLI), and needle injection (NI) of bleomycin and saline (100 μl) on ex vivo human skin. Three levels of air ventilation were explored: no ventilation, room ventilation, and room ventilation with an additional smoke evacuator. Results: EPI and SLI induced significant small-droplet aerosol formation compared with none after NI (0.2–1.0 µm; no ventilation). The largest bleomycin aerosol generation was observed for the smallest particles (0.2–1.0 µm) with 673.170 (528.802–789.453) aerosol particles/liter air (EPI; no ventilation). Room ventilation and smoke evacuation led to a reduction of ≥99% and 100% of measured aerosols, respectively. Conclusion: Jet injectors generate a high number of small-droplet aerosols, potentially introducing harmful effects to patients and healthcare personnel. Room ventilation and smoke evacuation are effective safety measures when chemotherapeutics are used in clinical practice.

Original languageEnglish
Pages (from-to)572-579
Number of pages8
JournalLasers in Surgery and Medicine
Issue number4
Publication statusPublished - Apr 2022

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© 2021 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.


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