Abstract
A case is presented of inadvertent intra-arterial injection of meperidine and promethazine. The initial sequence of events following injection was similar to that reported previously. Complete recovery ensued with the administration of intravenous heparin and corticosteroids. Consideration of the pathology seen with this accident suggests that the injury is a chemical endarteritis caused by a high concentration of drug delivered to the peripheral vessels. Immediate treatment should be instituted, including local sympathetic blocks, anticoagulation, and systemic corticosteroids. The basis of most inadvertent intra-arterial injections is the presence of an abnormal arterial branch adjacent to the intended vein. Prevention can best be accomplished by use of solutions containing low concentrations of the medication and by making sure that the needle is lying in the vein lumen for which it was intended.
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