Evaluation and management of accidental intra-arterial injection in the antecubital fossa

Abstract

Introduction: Intra-arterial (IA) drug injection is a rare, but a potentially serious medical emergency. It is most commonly seen as an iatrogenic complication when administering an intravenous (IV) medication. Accidental IA injection was defined as an IV injection administered in the upper limb for any illness, which was followed by sudden severe pain in the limb followed by bluish discoloration of any part of the affected limb. Aim: The aim of the study is to identify the risk factors early on for limb amputation following IA injection, to assess the efficacy of the various modalities of the treatments administered, and to establish a standardized treatment plan for IA injection to achieve limb salvaging. Materials and Methods: A total of 12 cases of accidental IA injection were studied for the efficacy of early evaluation and management of each. The patients were studied based on Rutherford classification, clinical history, and Doppler findings. Results: Ten out of the twelve patients presented early, and limb salvation was achieved. Conservative treatment and upper limb fasciotomy proved to aid with the limb salvation. However, two out of the twelve patients presented after 12 h with complains of blackening of the digits. In these patients, limb salvation was not achieved and Ray's amputation was performed. All the patients recovered well, with proper functioning of the upper limb. Conclusion: Early evaluation and management of a case of accidental IA injection is of utmost importance due to its serious complications. Finally, all medical professionals must be regularly trained to prevent such mishaps from happening.