Accidental Intra-Arterial Injection during Test Dose of Injection of Benzyl Penicillin: Complications and Management—A Case Report

Amarjit Singh,Kuldip Singh Sidhu,Shivaji Rai

doi:10.4236/crcm.2015.46043

Abstract

An 18 years old female patient was given a test dose of Benzyl penicillin in the Antecubital Area on the right forearm by a staff nurse of the department. After the injection, the patient complained of severe pain in the right forearm distal to the injection site. This was followed by blanching of the right forearm and hand. She was immediately heparinised followed by other symptomatic treatments. After 12 hours, a bluish discoloration developed on the hand, both on dorsal and palmar aspect, sparing the thumb. This recovered with medication, except the late development of dry gangrene of the tip of distal phalanx of the little finger which got shrivelled later on. Color Doppler flow study, echocardiography, and CT angiography of the right upper limb were done. Understanding of the pathogenesis and prompt action can help in saving a limb. Education of the medical professionals involved in administering injection is necessary so that they become aware of abnormal course or anomalous anatomy of vessels of upper limb. This can help to prevent the complications.

Highlights

Accidental intra-arterial injection of medication may lead to severe morbidity [1] [2]
Intra-arterial cannulation can occur in any age group but IA cannulation with penicillin [5] [7] [8] is common in babies
The paramedical staff who are involved in the administration of injections should be well trained and be well aware of complications resulting from accidental intra-arterial cannulation

Summary

Introduction

Accidental intra-arterial injection of medication may lead to severe morbidity [1] [2]. (2015) Accidental Intra-Arterial Injection during Test Dose of Injection of Benzyl Penicillin: Complications and Management—A Case Report. Intra-arterial cannulation can occur in any age group but IA cannulation with penicillin [5] [7] [8] is common in babies Nowadays, it is increasingly seen in IV drug abusers [3] [9]. Wrong site selected for testing, and wrong technique on the part of ancillary staff all may lead to accidental cannulation of an artery This may result in serious sequeale like severe pain, pallor, motor dysfunction, compartment syndrome, gangrene of distal part and rarely limb loss [1] [2] [10]. The paramedical staff who are involved in the administration of injections should be well trained and be well aware of complications resulting from accidental intra-arterial cannulation

Case Report

Singh et al Packed cell volume

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