Unintentional intra-arterial injection: Difference between revisions
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Background | '''Background'''<br /> | ||
Risk Factors | Accidental intra-arterial cannulation and administration of medications can result in severe pain, paresthesias, swelling. In severe case, direct vascular and tissue injury can progress to compartment syndrome, gangrene and even auto-amputation. This is significant and potentially severe complication of medication administration that every provider should be able to recognize. Must consider this scenario any time patient begins complaining of paresthesias or pain distal to IV site. Self-inflicted cases are also being described in patients with IVDA | ||
'''Risk Factors''' include:<ref>Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref> | |||
* Obesity | * Obesity | ||
* Hypotension | * Hypotension | ||
* Procedurally difficult situations (ie. agitated patient, back of ambulance) | |||
* Aberrant vascular anatomy | |||
Management: | '''Pathophysiology:''' | ||
# Maintain catheter in place to | Is often multifactorial and dependent upon type of medication administered. Theories include NE induced vasospasm, crystal formation, venous constriction, lipid solubility, direct cytoxicity, endothelial damage and high osmolality. All pathways suggest the primary mediator of tissue injury is '''thrombosis'''<ref>Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref> | ||
'''Medications known to cause severe injury if administered IA:''' | |||
* Benzodiazepines | |||
* Barbiturates | |||
* Propofol | |||
* Penicillins | |||
* Amphetamines | |||
* Phenothiazines | |||
* Phenytoin | |||
* Heroin | |||
* Tubocurarine | |||
* Atrcurium | |||
* TPN | |||
* NaHCO3 | |||
* Hypertonic Dextrose (D50) | |||
'''Management:''' | |||
# Maintain catheter in place - to be used for arteriogram and administration of vasodilators | |||
# Thoroughly evaluate medications administered through this catheter | # Thoroughly evaluate medications administered through this catheter | ||
# Evaluate severity of injury (soft compartments, neuro-vascular exam) | # Evaluate severity of injury (soft compartments, neuro-vascular exam) | ||
# Consider anticoagulation with heparin initial loading dose 60IU/kg | |||
# Treat pain and symptoms | # Treat pain and symptoms | ||
# | |||
'''Treatment:''' | |||
* Hypertonic dextrose - no antidote | |||
# Serial compartment exams | |||
# Pain control | |||
Revision as of 16:25, 3 June 2016
Background
Accidental intra-arterial cannulation and administration of medications can result in severe pain, paresthesias, swelling. In severe case, direct vascular and tissue injury can progress to compartment syndrome, gangrene and even auto-amputation. This is significant and potentially severe complication of medication administration that every provider should be able to recognize. Must consider this scenario any time patient begins complaining of paresthesias or pain distal to IV site. Self-inflicted cases are also being described in patients with IVDA
Risk Factors include:[1]
- Obesity
- Hypotension
- Procedurally difficult situations (ie. agitated patient, back of ambulance)
- Aberrant vascular anatomy
Pathophysiology: Is often multifactorial and dependent upon type of medication administered. Theories include NE induced vasospasm, crystal formation, venous constriction, lipid solubility, direct cytoxicity, endothelial damage and high osmolality. All pathways suggest the primary mediator of tissue injury is thrombosis[2]
Medications known to cause severe injury if administered IA:
- Benzodiazepines
- Barbiturates
- Propofol
- Penicillins
- Amphetamines
- Phenothiazines
- Phenytoin
- Heroin
- Tubocurarine
- Atrcurium
- TPN
- NaHCO3
- Hypertonic Dextrose (D50)
Management:
- Maintain catheter in place - to be used for arteriogram and administration of vasodilators
- Thoroughly evaluate medications administered through this catheter
- Evaluate severity of injury (soft compartments, neuro-vascular exam)
- Consider anticoagulation with heparin initial loading dose 60IU/kg
- Treat pain and symptoms
Treatment:
- Hypertonic dextrose - no antidote
- Serial compartment exams
- Pain control
- ↑ Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795
- ↑ Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795