Accidental Intra-arterial Injection Research Articles

Inadvertent intra arterial injection of Rocuronium: A case report

Accidental intra-arterial injection of drugs is a potentially dangerous complication of intravenous therapy. All the personnel using intravenous therapy must be aware of this possibility and signs symptoms and management of it. We report a case of accidental intra-arterial injection of Rocuronium and Fentanyl. Patient developed sever hyperemia and sluggish capillary refill distal to site of injection. The patient was given injection lignocaine 2% 60 mg and 30 ml of heparinised saline was infused intra-arterial. The hyperemia resolved slowly and capillary refill improved back to normal over next hour. There were no long terms sequelae.

Acute ischaemia of the leg following accidental intra-arterial injection of dissolved flunitrazepam tablets

Accidental intra-arterial injection of drugs is a sporadic complication in i.v. drug addicts. A 22-year-old drug-abuser injected flunitrazepam tablets dissolved in tap water into her left femoral artery and presented with clinical signs of acute ischaemia of the left leg. Severe rhabdomyolysis developed within 5 hours after the injection. Selective arterial catheter angiography showed an acute occlusion of the posterior tibial artery. Combination therapy with i.a. urokinase, i.a. prostaglandines and i.v. anticoagulation resulted in re-opening of the obstructed distal artery and complete cessation of symptoms.

Rhabdomyolysis following Accidental Intra-arterial Injection of Local Anesthetic

Drug-induced myopathy, also named Nicolau syndrome, is a well-known phenomenon following intramuscular injection of certain agents, most commonly reported with penicillin or diclofenac. The mechanism responsible for the pathology is proposed to be incidental administration of the drug into the small arterioles. In this report, we present a Nicolau syndrome-like case that developed following accidental injection of a local anesthetic agent into the femoral artery during coronary angiography.

Kombinierte Nervenschäden und Embolia cutis medicamentosa nach intraglutäaler Fehlinjektion

Injection-induced palsy of the ischiatic nerve with concomitant damage of other peripheral nerves occurred in two patients following intramuscular injection in the upper outer quarter of the large gluteal muscle. In close chronological connection skin changes developed in both cases representing drug-induced cutaneous embolism, and in one case extensive muscular necrosis was observed. In both cases the cause may be assumed to be ischaemic neuropathy following embolic occlusion of the vasa nervorum as a result of accidental intraarterial injection.

Acute paraplegia and pulmonary edema after benzathine penicillin injection

Accidental intra-arterial injection is a potentially devastating complication of the intragluteal injection of benzathine penicillin. A 35-year-old woman developed after intramuscular injection of benzathine penicillin G acute paraplegia and noncardiogenic pulmonary edema. Noninvasive positive pressure ventilation was initiated with furosemide and corticosteroids. A magnetic resonance imaging scan showed findings consistent with syringomyelia and spinal cord ischemia at T9 through T10. Vascular injury may be the result of microemboli of the injected crystals of the penicillin salts. The mechanism of noncardiogenic pulmonary edema is perhaps an immunogically mediated one. At 2-year follow-up, she had no improvement in neurologic status. The deficit is considered permanent.

Unrecognized hand ischemia after intraarterial drug injection: successful management of a "near miss" event

BackgroundComplications arising from accidental intraarterial drug injections have been described in the past. However, given the multitude of injected substances and complex pathophysiology, guidelines regarding diagnosis and management of patients with intraarterial injections remain vague. As such it remains unclear, when to expect limb ischemia and whether and for how long to monitor patients after intraarterial injections.Case reportWe present the case of a "near miss event" in an i.v. drug abuser presenting to the emergency department 3 hours after injection of water dissolved zolpidem (Ambien™) tablets into the right ulnar artery. Chief complaint was forearm pain. Clinical examination at the time revealed no concern for limb ischemia and patient was discharged. The patient returned unplanned 18 hours after injection with an ischemic right hand. Angiography revealed no flow in the distal ulnar artery and minimal flow in the palmar arch. Emergent intraarterial thrombolysis with Urokinase was performed and restored hand perfusion. Clinical follow-up 3 months after injury showed full recovery with regular recapillarisation and normal Allen test.ConclusionThis case report highlights the need to rigorously monitor patients with suspected intraarterial injections for potential delayed onset of limb ischemia. This is to our knowledge the first described case report of a successful revascularization after prolonged ischemia with delayed onset after zolpidem injection. We recommend close monitoring of these patients for at least 24 hours in addition to starting prophylactic anticoagulation.

UPPER LIMB MORBIDITY AS A DIRECT CONSEQUENCE OF INTRAVENOUS DRUG ABUSE

To quantify and qualify the types of upper limb injuries admitted to hospital as a direct result of illicit intravenous drug use (IVDU). A retrospective case series identified all inpatient admissions for upper limb injuries as a direct result of IVDU over a two-year period. The type of injury, procedures, complications, co-morbidities, relevant investigations and other notable events during admission and follow-up were identified. Thirty-six people were admitted with upper limb injuries. Infective presentations (abscess, cellulitis, osteomyelitis, and septic arthritis) were most common. Other injuries were due to accidental intra-arterial injection, soft-tissue necrosis and compartment syndrome. Microbiological analysis from abscesses showed a high frequency of multiple organisms, and most commonly identified Streptococci, Staphylococcus aureus, and anaerobes. These patients had high rates of hepatitis C, malnutrition, psychiatric and behavioural co-morbidities; 77% were lost to follow-up. The most common injuries from IVDU are infections, and ischaemia. High rates of concurrent medical and psychosocial co-morbidities add further challenges to effective patient care.

Accidental intra-arterial injection of midazolam and pethidine during endoscopy: a reminder that a routine procedure can result in disaster

Accidental intra-arterial injection of midazolam and pethidine during endoscopy: a reminder that a routine procedure can result in disaster

Propofol-induced vascular permeability change is related to the nitric oxide signaling pathway and occludin phosphorylation

The present study was undertaken to elucidate the mechanism of intra-arterial propofol-induced vascular permeability change resulting in tissue edema. The mechanism of propofol-induced hyperpermeability was examined in a rat femoral artery injection model. Vascular permeability was determined by measuring the Evans blue content of the dorsal skin of the infused limb at 15, 30, 45 and 60 min after propofol injection. The total content of the tight junction proteins occludin, ZO-1 and claudin-5 under experimental conditions was also determined by western blotting. Intra-arterial injection with propofol resulted in a marked dose-dependent increase in vascular permeability of the rat hindpaw. Pretreatment with 10 mg/kg of N-nitro-L: -arginine methyl ester (L: -NAME) but not aminoguanidine significantly inhibited the change in vascular permeability after challenge with propofol. Pretreatment with L: -arginine and nitroprusside increased the propofol-induced permeability change. Intra-arterial injection of propofol significantly increased occludin phosphorylation after 15 min, which was consistent with the time profile of the vascular permeability change. L: -NAME partially reversed the change in occludin phosphorylation, whereas aminoguanidine had no effect compared with that in the controls. Our observations indicate that nitric oxide (NO) is an important mediator in the induction of vascular permeability induced by propofol. Occludin phosphorylation is a determining factor in the vascular permeability change induced by propofol. NO synthase (NOS) inhibitors might be useful in the treatment of accidental intra-arterial injection of propofol, in the reduction of any adverse effects.

Akute Ischämie der Hand nach intraarterieller Flunitrazepaminjektion

Three drug addicts presented as emergencies with severe pain in one hand. 1 to 3 hours previously they had accidentally injected dissolved flunitrazepam tablets intra-arterially. The affected hands were pale and cold. Two of the patients had injected into the brachial artery, one into the radial artery. The brachial and radial arteries were palpable in all three patients, but immediate angiography showed complete occlusion of all arteries to the hand and fingers. Initial local treatment with intra-arterial infusion of prostanoids (PGE(1)) did not improve hand perfusion. Subsequently, a combination of PGE(1) and local fibrinolytic therapy with rt-PA was given intra-arterially over 12 to 22 hours. In two of the patients complete reperfusion was achieved, but one, in whom the delay between injection and treatment had been the longest, lost the distal phalanges of digits 1, 2 and 3. No bleeding complications were observed. Peripheral ischemia as a result of an accidental intra-arterial injection of dissolved tablets in drug addicts is an emergency which requires immediate action. The combined administration of prostanoids and rt-PA-lysis is a promising therapeutic option that should be employed in such patients.

Accidental Intra-Arterial Injection: A Case Report, New Treatment Modalities, and a Review of the Literature

Accidental intra-arterial injections of medications in the upper limb, although infrequently described in the literature, are serious complications of intravenous drug therapy with potentially disastrous consequences. While it has been reported that early intervention is of the utmost importance when faced with this predicament,1 there is still no well-established therapy in treating such patients. We describe a case below involving an inadvertent intra-arterial injection of promethazine HCl. We also review the literature in order to identify patient risk factors, medications associated with a higher morbidity after intra-arterial injection, and various new therapies advocated when treating this complication.

Arterial variations of the upper extremities

During the dissection of the right and left upper limbs of a 70-year-old female cadaver, we encountered combined vascular anomalies. On the left side, we observed the presence of a lateral inferior superficial brachial artery, large anterior interosseous artery and an absence of a radial artery, which is quite a rare anomaly. The lateral inferior superficial brachial artery that arose 39 mm distal to the brachial artery descended to the wrist. The anterior interosseous artery originated from the brachial artery at the level of 12 mm distal to the head of the radius and descended on the anterior aspect of the interosseous membrane with the anterior interosseous branch of the median nerve. On the right side, a trifurcation of the brachial artery was observed. It gave off three terminal branches: the radial, ulnar and a muscular artery at the proximal one-third of the humerus. It is obvious that accurate information concerning unusual patterns of the arteries in the upper limbs is relevant clinically, especially in order to avoid accidental injury or intra-arterial injection.

The local effects of intra-arterial injections of sodium tetradecyl sulphate (S.T.D) 3 per cent. An experimental study.

Abstract The accidental intra-arterial injection of the commonly used sclerosant sodium tetradecyl sulphate (S.T.D.) 3 per cent during the treatment of varicose veins can affect seriously the blood-supply to the limb, and gangrene may follow. Intra-arterial injection of S.T.D. into the limb arteries of dogs chemically disintegrates the blood in the slow-moving stream of the capillaries and converts it into a thick sludge which obstructs the circulation locally, resulting in necrosis of the extremity.

Accidental intra-arterial injection during sclerotherapy of varicose veins.

Abstract Five cases of accidental intra-arterial injection of sodium tetradecyl sulphate during the treatment of varicose veins are presented and compared with 3 previously reported cases. Severe ischaemic damage with gangrene may occur. Immediate treatment with heparin and low molecular weight dextran may be of value in the management of this situation.

Akzidentelle intraarterielle Injektion von Diacetylmorphin (Heroin) bei Drogenabhängigen

Accidental intrarterial injections are not uncommon in medical treatments. This is also true for uncontrolled injections by drug-addicts. Since 2002 a number of 600 heavy opiate addicts in Germany are substituted in a country-wide study with pure diacetylmorphine (Heroine). We report the course and outcome of three cases of accidental intraarterial injections of pure diacetylmorphine under controlled conditions. After initial symptoms of vasospasms, all cases were without symptoms within one hour and no obvious loss of tissue was observed. After discussing the literature about medical literature and treatment options in intraarterial injections it is concluded, that the cause of major complications after intraarterial injections may not be the pure diacetylmorphine but additional substances in impure "street-heroin" samples.

Iatrogenic Digital Gangrene: Report of a Case

OBJECTIVE: The rationale of this report is to highlight warning signals and to suggest methods of minimizing the severity of the gangrene. METHOD: A 20 year old male developed gangrene of the right thumb, index and middle fingers following what was suspected to be an accidental intra-arterial injection of ketamine as an anaesthetic agent. RESULTS: Dry gangrene of the right thumb, index and middle fingers and of the right thenar eminence CONCLUSION: During administration of any intravenous drug (including and especially anaesthetic agent), aspiration of bright red blood should alert the doctor that an artery has been cannulated. Pulsation (if elicited) along the vessel concerned should be confirmatory, and such injection discontinued. Nig Jnl Orthopaedics & Trauma Vol.2(2) 2003: 134-136

Accidental Intra-arterial Injection of Vecuronium: A case report

One of the complications of direct arterial pressure monitoring is drug injection through an arterial line mistaken for an intravenous line. We experienced a case of accidental intra-arterial vecuronium injection through an arterial line on the right radial artery. The incident was noticed just after the injection and the patient was treated by intra-arterial injection of heparin, papaverine, lidocaine and stellate ganglion block. No color change or edema of the right hand was observed until the end of operation. The patient was closely observed after operation and discharged without complication. We report a case of accidental intra-arterial vecuronium injection which was managed successfully.

Thoracoscopic sympathectomy for symptomatic arterial obstruction of the upper extremities

Background. Severely symptomatic arterial insufficiency of the hand and upper extremities requires adequate treatment. Medical therapy and local care are usually unsuccessful, and thoracic sympathectomy can represent an effective procedure to control pain, to help ulcer healing, and to prevent or delay amputation. Methods. We performed 20 thoracoscopic sympathectomies in 15 patients (13 men and 2 women) with upper extremity ischemia. Mean age was 47 years (range 21 to 72 years). All patients were thought to have organic blockage of digital arteries. The condition was unilateral in 10 patients and bilateral in 5. Primary diagnosis was digital arteriosclerosis in 8 patients, Buerger’s disease in 4 patients and the remaining 3 were drug abusers with severe ischemia due to accidental intraarterial injection of drugs. Eleven patients (73%) presented with terminal digital necrosis, gangrene, or ulceration of the fingers associated with severe pain. Four patients complained of coldness, pain, and some degree of soft tissue infection without permanent loss of tissue. Results. We performed 10 unilateral and five bilateral staged (mean interval was 3 months) thoracoscopic sympathectomies. We had two minor complications and no mortality. Mean duration of postoperative chest drainage was 2.5 ± 0.4 days and mean postoperative hospital stay was 5.3 ± 0.5 days. Follow-up ranged from 3 to 71 months, with a mean of 33 months. All patients demonstrated clinical benefit after operation. Conclusions. Thoracoscopic sympathectomy in patients with severe ischemia of upper limb extremities permits optimal symptomatic control and maximum tissue salvage. Because the procedure is minimally invasive, safe, and associated with a low rate of complications, it should be considered earlier the natural course of this disease.

Accidental Intraarterial Drug Injections via Intravascular Catheters Placed on the Dorsum of the Hand

Accidental Intraarterial Drug Injections via Intravascular Catheters Placed on the Dorsum of the Hand

Accidental intra-arterial injection via the venous limb of a dual pressure transducer system

Accidental intra-arterial injection via the venous limb of a dual pressure transducer system