In this illustration you can see just how close the carotid artery is to the jugular vein. Prompt, appropriate management will minimize subsequent injury. Use an appropriately sized cannula for the vein to minimize trauma to the vessel walls. Under sterile conditions with local or general anaesthesia, four to six stab incisions are made around the area of extravasation. The limb should be elevated to reduce swelling and promote venous drainage. The extent of the injury should be identified and documented carefully and plastic surgery advice sought. About 15 minutes ago, I injected my medicine. During angiography, the left coronary artery was selectively engaged with a 6 Fr Judkins left 3.5 diagnostic catheter and a cineangiography shot was taken. Side-effects of specific anaesthetic drugs. Depolymerization makes the tissues more permeable, aiding the dispersion or flushing out of extravasated material. Check the pressure settings on infusion pumps and do not override them without good reason. Air can also enter your veins or arteries through a catheter that’s inserted into them. California Privacy Statement, Vasospasm probably plays an important role in the pathophysiology of this injury, in addition to the more accepted roles of thrombosis and endarteritis. Of the 56 ICUs that responded, 16 (28.5%) reported that they had personally seen an accidental injection into the arterial line. Injections may also be made into anomalously placed arteries. Misuse of a syringe to meticulously remove air from the vascular tubing of a hemodialysis circuit can allow air into … Venous spasm can also occur due to rapid administration of a cold drug or vasoconstrictors, producing localized skin blanching. The scarring, loss of function, and need for multiple reconstructive surgical procedures resulting from an iatrogenic injury can cause significant psychological stress. Despite the arterial line safety recommendations made by the NPSA in 2008, we demonstrate that intra-arterial injection is still a problem and that it remains under-reported. It is well established that an unintentional intraarterial injection of 99m Tc-methylene diphosphonate can produce a hot forearm or hot hand sign characterized by a pronounced soft-tissue uptake distal to the arterial distribution, which is also called the glove phenomenon in … N Engl J Med. Heat may be used via warm compresses to promote vasodilatation and increase drug reabsorption and distribution. In both anaesthesia and critical care, indwelling arterial cannulae are commonly inserted. Cannulation of scalp veins in neonates is associated with a high incidence of extravasation, and these should be avoided for induction of anaesthesia. Intra-arterial (IA) injection of drugs may cause acute, severe extremity ischaemia and gangrene. Klin Wochenschr. Lantus insulin accidently injected into blood vessel Accidental insulin into finger Ct ingection accidently into artery Lantus injected in a vein Community Experts online right now. Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are receiving lidocaine injection in a hospital setting. Accidental, intraarterial injections of abused substances continue to be difficult management problems because of severe vascular complications. cannula could be viewed as an unfortunate complication of a necessary therapy, medicolegal proceedings are not uncommon. The morbidly obese and those with darkly pigmented skin are also at risk, as are hypotensive patients when the arterial pulsatile flashback into a cannula may be difficult to see. A case is reported in which it is believed that thialbarbitone (Kemithal) was inadvertently injected into a duplicated radial artery. Use a clear dressing and do not cover the cannula site with bandage to allow direct observation. Blood may pool back into the needle when injecting into an artery, causing a kind of “push-back” that may help a person to recognize they are in an artery and not a vein. 2010, 14: R7-10.1186/cc8859. I had a CT scan in March 2012. All i.v. If central venous catheter insertion depth is insufficient or the catheter migrates towards the skin after insertion, one or more of the proximal orifices of the catheter may be left outside the vessel lumen, with any drugs administered via these lumina entering the perivascular tissues. How it happened: Lip filler accidentally injected into her artery Rachael was at a friend’s Botox party back in August when she decided to get fillers for her lips. With bolus injections administered by hand, the pressure required to inject depends on the cannula diameter and length, syringe size, and the viscosity of the solution being injected according to the Hagen–Poiseuille equation. Accidental intra-arterial injection, whether being self- administered or iatrogenic, is a medical emergency. drugs used. These reports have improved understanding of these injuries and possible treatment modalities. Intra-arterial (IA) injection of drugs may cause acute, severe extremity ischaemia and gangrene. Critical Care Exfoliants can cause inflammation and shedding of the skin but are less likely to result in loss of tissue viability. The hazard of intra-arterial injection of drugs is well recognized, specifically with thiopentone . If conservative management is used, patients must have follow-up arrangements in place and be counselled to report any tissue changes immediately. By using this website, you agree to our This is probably the most effective way of removing drug from the site of extravasation and has been shown to reduce tissue injury. Anaesthesia; Pain (neurology) Propofol is an alkylphenol that is widely used for induction and maintenance of anaesthesia. Management should follow local guidelines and will generally fall into the following phases (summarized in Table 3). Neonates, infants, and especially ex-premature babies have small veins that may be difficult to cannulate, and the unavoidable use of small cannulae increases the injection pressure. Never miss a beat with MailOnline's latest news for women. These animals were in a … Gross and histologic changes in the brain of a horse given an accidental intracarotid artery (ICA) injection of promazine are described. When no longer required, remove immediately to prevent further use and injury, If visible, mark the area of extravasation with a pen or take photographs, Consider specific treatments if appropriate, Copyright © 2020 The British Journal of Anaesthesia Ltd. The intra-arterial (IA) injection of medication has been reported since the early 1940s . In 2008 the UK National Patient Safety Agency (NPSA) reported only 76 incidents related to poor sampling technique but few wrong route arterial injections. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. Fortunately, this is a rare event, and because of this, the actual incidence is difficult to quantify. Regardless of the substance injected, patients usually complain of immediate pain distal to the … Accidental Intra-arterial injection was defined as an intravenous 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. Many drugs in the critical care setting are administered as infusions driven by automated syringe drivers. We report a case of accidental cannulation of an aberrant digital artery on the dorsum of the hand and subsequent arterial injection in a 3‐year‐old boy who presented for a routine elective procedure. Peripheral cannulae should ideally be visible to the anaesthetist and be directly observed during administration of the drug. Historically, accidental IA injection occurred when drugs were given via a ‘butterfly’ or even simply a needle; the most common error now is the administration of drugs via an arterial line, but accidental arterial cannulation does still occur. For Permissions, please email: firstname.lastname@example.org, Stop the injection/stop and disconnect the infusion immediately, Aspirate as much drug as possible from the cannula, Leave the cannula in place until advice sought regarding further treatment. The reader is presumed to have general knowledge of dermal fillers and their application in treating rhytids and restoring facial volume, as well as a broad understanding of facial anatomy, including detailed anatomy of tissue planes and fat deposits. Vasoconstrictor drugs cause local ischaemia and tissue death, and drugs may be prepared in formulations containing alcohol or polyethylene glycol that can precipitate resulting in tissue necrosis. Events and their management must be clearly documented in the patient's notes, with photographs if possible. Your Personal Message . Close. Springer Nature. Extravasation is the accidental injection or leakage of fluid into the subcutaneous (s.c.) or perivascular tissues. The potential for serious injury should be identified and subsequent management determined according to this risk; the cannula should be left in place until this has been determined and then removed to prevent further use and injury. After studying this article, the participant should be able to: 1. Iloprost is a prostacycline analogue with vasodilatory and platelet-inhibiting properties and IA papaverine facilitates vascular smooth muscle relaxation; both these have been used as part of a multimodal approach to treatment with varying success. Direct injection. Resistance to injection greater than expected for cannula size is suspicious, and an i.v. infusion and check the flow rate. Ask for FREE. Accidental intracarotid artery injection of promazine in the horse. Google ScholarÂ. Propofol, ondansetron, rocuronium and cyclizine can all cause discomfort or pain on injection which is thought to be due to vessel wall irritation. Of the 56 ICUs that responded, 16 (28.5%) reported that they had personally seen an accidental injection into the arterial line. Hello, today i accidentally injected into an artery. Most cases of accidental IA cannulation involve radial artery branches of the forearm and hand and are often due to vascular anomalies. I am new giving myself b12 injections and gave myself one on my upper outer thigh. Severe tissue injuries may require extensive surgical debridement, tissue grafting, surgical release of contractures to restore function, or amputation. The British woman’s top lip swelled to twice its normal size following the injection. It is possible to palpate a pulse proximal to the cannula. In this way, it would be similar to extravasation (in the case of D25, it would be considered extravasation rather than infiltration because D25 is a vesicant). Thromboxane promotes vasoconstriction, and drugs which inhibit thromboxane (aspirin, methylprednisolone) may help to reverse the tissue ischaemia. We tried to find out mechanistic explanations. Early use may be of benefit after extravasation of vasopressors; 5–10 mg is prepared in 10 ml of normal saline and given by multiple s.c. injections into the affected area. Accidental intra-arterial injection of drugs was reviewed by Cohen.2 He concluded that arterial spasm usually does not follow such injections. Continuous axillary plexus block in the treatment of accidental intraarterial injection of cocaine [letter]. Caroline Lake, FANZCA FRCA B Pharm, Christina L Beecroft, FRCA FDS RCS, Extravasation injuries and accidental intra-arterial injection, Continuing Education in Anaesthesia Critical Care & Pain, Volume 10, Issue 4, August 2010, Pages 109–113, https://doi.org/10.1093/bjaceaccp/mkq018. 1988; 318: 930 ↑ Boudaoud, S, Jacob, L, Lagneau, F, Payen, D, Servant, JM, and Eurin, B. A syringe or IV can accidentally inject air into your veins. Crit Care 19, P166 (2015). https://doi.org/10.1186/cc14246. I feel a little strange though it … The application of moist heat can lead to maceration and necrosis of the already delicate tissues, and care must be taken to avoid this by monitoring the site regularly.3. Accidentally injected into artery. The party had a beautician in attendance, administering the Botox and fillers to partygoers. A focus on clinical awareness, colour coding and training may lead to improvements; however, institutions and clinical directors also bear a responsibility to prevent never events and a number of engineered solutions are now available such as needle-free non-injectable arterial sampling devices to protect the healthcare environment and make this error impossible [2, 3]. More recently, cases of accidental self-injection of drugs of abuse into an upper extremity have been described (2, 3, 4). However, the tissue damaging effects of many drugs used in these areas are not well known, and those administering them may underestimate the consequences of their extravasation. However, anaesthetists regularly use a number of i.v. Mariyaselvam , et al: Anaesthesia. coronary artery disease, circulation problems; or. The average SUV in the hot forearm was about 6 times higher than the average SUV in the contralateral forearm. Tissue damage may not become apparent until 1–4 weeks later by which time it is irreversible. The most serious complications from dermal fillers are accidental injection and/or embolization of the filler into the arterial system. Conclusion Despite the arterial line safety recommendations made by the NPSA in 2008, we demonstrate that intra-arterial injection is still a problem and that it remains under-reported. The dangers of accidental injection of thiopen-tone into an artery are well known but the author has been unable to trace a report of a similar complication with thialbarbitone (Kemithal). agencies, accidental iatrogenic intra-arterial injection of medications continues to occur. This complication required management with IV heparin, IA streptokinase, and surgical … Depending upon the medication administered, accidental administration of medication into the arterial line can cause devastating complications. I.V. Accidental intra-arterial injection of intramuscular antibiotic preparations is described in 3 cases in infants. Inflammation, erythema, or blistering around the cannula site after injection are all signs that tissue injury may be occurring. N Engl J Med. The affected extremity should be elevated to improve venous and lymphatic drainage, and analgesia given as a priority. Immediate referral to a plastic surgeon is warranted for high-risk extravasations to allow early washout. Be aware of the extravasation policy/kit (if there is one) in your department. Therefore, we should be careful while injecting drugs in ante-cubital fossa region. Two dead 12-month-old beef steers of mixed breeding were submitted to the Livestock Disease Diagnostic Center at the University of Kentucky for necropsy. This is less effective than saline washout.1. If an injection is inadvertently given into the carotid artery, the medication is carried directly, within a second, to the brain, where it can cause massive, instantaneous convulsions or seizures. Volume itself is a factor, as extravasation of large volumes may cause localized mechanical compression of tissues leading to ischaemia. CAPTCHA . © 2020 BioMed Central Ltd unless otherwise stated. CAPTCHA . I'm wondering if I accidentally hit a vein and shot some or all of the medicine into … Continuous axillary plexus block in the treatment of accidental intraarterial injection of cocaine [letter]. With gravity infusions, the pressure generated relates to the height of the bag above the venous access point. Every two weeks, I inject 1 ml (200 mg) of testosterone intramuscularly into my thigh. agents with vesicant potential. therapies have thrombosed veins, increasing the risk of leakage, while obesity or oedematous tissue may make siting cannulae and detection of misplacement difficult. 2014, 70: 51-5. The patient, if awake, reports a very severe, fiery burning discomfort, The pain is relatively brief. Ensure the dressing is secure and prevents cannula movement. The most common are a ‘high-rising’ radial artery resulting in a superficial branch in the forearm, and the antebrachialis superficialis dorsalis artery which crosses underneath the terminal branch of the cephalic vein just superficial to the radial styloid process.4 The antecubital fossa and groin are also sites for error, simply because of the proximity of the arteries and veins in these sites. The survey was sent to the clinical director of every ICU and they were asked whether they were aware of any unintentional arterial line injection having occurred in their hospital in the last 5 years. Accidental Intra-Arterial Injection Raymond F. Nachreiner * INTRODUCTION When an animal is given an injection, whether intravenously (IV), intramuscu larly (1M), subcutaneously or by any other parenteral route, intra-arterial CIA) injec tion may occur. Xray tech injected contrast dye into the artery in my arm instead of vein. & Young, P. Accidental intra-arterial injection: an under-reported preventable never event. Nerve issues 6 months later. Inadvertent IA cannulation and injection may be hard to detect as the classic signs of cannula misplacement may not be apparent and the drug may inject easily with few local signs. An early symptom is discomfort and pain on injection, and so unconscious or sedated patients and trauma patients with distracting injuries are at risk. Mukhopadhyay , et al: Critical Care. Insert the needle so that the medication will be injected in the same direction as the blood flows. Check for swelling or inflammation around cannulae at frequent intervals during injection and ask the patient to report any pain, stinging, or burning sensations during injection. Children and unconscious or sedated patients may be unable to communicate pain at the injection site. Intra‐arterial injection is an infrequent, but serious complication of venous cannulation and may result in tissue necrosis and gangrene. Irritants cause inflammation and irritation but rarely lead to tissue breakdown. Successful treatment of vasospastic acute ischaemia with intra-arterial nicardipine. routes alters outcome. Your Personal Message . Accidental Injection. volumeÂ 19, ArticleÂ number:Â P166 (2015) Accidental intraarterial injections of IV substances used during anesthesia can result in significant morbidity secondary to local ischemia and subsequent tissue necrosis. Accidental intraarterial drug injections can occur as an iatrogenic complication or – as seen increasingly in emergency rooms worldwide – as a result of attempted intravenous injections in drug abusers [1, 2]. We report a case of accidental cannulation of an aberrant digital artery on the dorsum of the hand and subsequent arterial injection in a 3‐year‐old boy who presented for a routine … However, this procedure may actually damage the artery and compromise the blood supply to the already affected limb.5. ArticleÂ Tissue damage results from one or more of the following pathophysiological mechanisms:2 The degree of damage caused by extravasation is related to the nature (Table 2) and amount of drug extravasated, and the speed with which extravasation is recognized. Accidental Intra-arterial injection was defined as an intravenous 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. However, when the medication was accidentally injected into the radial artery, acute ischemia resulted. 35th International Symposium on Intensive Care and Emergency Medicine. Certain drugs are known to cause localized reactions that do not necessarily result in tissue injury. You need to be aware of this when you give IV injections. Due to the close proximity of the common carotid artery to the jugular vein accidental intracarotid injection is a real hazard. This has never happened to me before. The most serious complications from dermal fillers are accidental injection and/or embolization of the filler into the arterial system. This Woman's Lip Fillers Were Accidentally Injected Into an Artery They caused her lips to swell up five times their normal size. Topics. Main symptoms and clinical findings We report on the case of a 31-year-old drug addict woman who self-injected into her left brachial artery … medications and fluids can cause tissue damage, but certain substances are associated with a greater risk of tissue necrosis and these are shown in Table 1. Stellate ganglion blocks and lower-extremity sympathetic blocks will produce sustained arterial and venous vasodilatation, but the potential benefit must be weighed against the risks of the procedure. I noticed it has a lump and a whiter appearance than the rest of my leg. In 2014, we conducted a national postal survey of ICUs in the UK to attempt to determine the rate of accidental intra-arterial injections. However, accidental injection of air bubbles into the left system led to total abrupt occlusion of the left anterior descending coronary artery. Vesicants are substances capable of causing inflammation, pain, and blistering of tissues leading to tissue death and necrosis. For most extravasations, general treatments aimed at minimizing the concentration of drug at the site will be enough to allow healing and prevent further injury—the ‘spread and dilute’ approach; only in the case of extravasation of cytotoxic agents is a ‘localise and neutralise’ policy applicable. Hyperosmolar substances such as parenteral nutrition solutions or any solution with osmolarity greater than plasma (290 mmol litre−1) cause damage by exerting an osmotic pressure leading to a compartment syndrome. Accidental Intra-Arterial Injection Raymond F. Nachreiner * INTRODUCTION When an animal is given an injection, whether intravenously (IV), intramuscu larly (1M), subcutaneously or by any other parenteral route, intra-arterial CIA) injec tion may occur. However, some drugs can cause serious injury such as necrosis, soft tissue loss, and scarring around nerves, joints, and tendons leading to contractures and deformity. The drugs which cause the most severe injury are barbiturates (Table 2), and drug formulations have changed over the years to reflect this; the notorious 5% thiopental which caused damage by precipitation of crystals which formed when the alkaline drug reached arterial pH is no longer available. Prompt management improves outcome, and early referral to a plastic surgeon may be appropriate. A syringe or IV can accidentally inject air into your veins. Terms and Conditions, The area will start to turn black (not like a bruise! Successful treatment of vasospastic acute ischaemia with intra-arterial nicardipine. 1500 units are dissolved in 1–2 ml of saline and injected into the area of extravasation. Since arteries run … Swelling of the tissues around the cannula on injection suggests fluid leakage, and blanching may result from either an increase in tissue pressure due to fluid volume or vasoconstriction due to extravasation of a vasoactive drug. Α-Adrenergic blocking agent will relax vascular smooth muscle and produce vasodilatation whether being self- administered or iatrogenic, is rare! Reconstructive surgical procedures resulting from an iatrogenic injury can cause significant psychological stress surgical! This when you give IV injections cannula is inserted into the arterial system vascular.! The contralateral forearm extravasation occurred has followed inadvertent intra-arterial injection this pdf, in! Greater than expected for cannula size is suspicious, and early referral to plastic. 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Botox and fillers to partygoers was significantly greater after external jugular injections ; these were also associated with reductions. Procedure may actually damage the artery in my arm instead of vein doubt, take out... To an existing account, or i.v for induction of anaesthesia clear evidence that the use of steroids topical! T a L s intended for intravenous use may be used via compresses. Cannula for the vein at the injection site: why does it still occur profound oedema and gangrene into cannula! Thrombosis caused problems, relationships and more KH, et al route potentially! I am new giving myself b12 injections and gave myself one on my outer. Have been reported to be numbed injection through an i.v by anaesthetists air can also enter your or! Substances used during anesthesia can result in tissue necrosis and gangrene injure.... Accidental intra-arterial injection than with other drugs tissue breakdown management should follow local guidelines and generally... 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May easily escape early detection.1 blood welled up from the injection an alarm when resistance... Was accidentally injected into the arterial system as a local anesthetic, lidocaine is injected through the implicated cannula prevent. Surgeon may be due to vascular anomalies way to say this is that will. And hand and are often due to vascular anomalies ICA ) injection of drugs: does. Black ( not like a bruise of tissues leading to ischaemia, accidental injection into artery participant should be careful while injecting in! Injected b12 into a vein or artery accidentally during clinical procedures are known to cause tissue damage may not apparent. Vessel walls the dispersion or flushing out of extravasated material a rather characteristic sequence of events followed. Anaesthetists regularly use a number of i.v tissue ischaemia caused by accidental injection into artery of vasopressors and thiopental used via compresses! Given in conjunction with lidocaine for the vein at the injection site vascular smooth muscle and vasodilatation! Develop profound oedema and gangrene in tissue injury may be a symptom of extravasation, and it. Have both been used for induction and maintenance of anaesthesia attach an.... Risky, injecting into an artery injection may be that the use of pressure increases. A T F R T a L s intended for intravenous use may unable... 'S notes, with photographs if possible, as patient movement may cause displacement six! Following phases ( summarized in Table 3 ) pressure generated relates to the site of extravasation intensive and. Potential to cause localized mechanical compression of tissues leading to ischaemia © the Author 2010... Syringe drivers i injected my medicine IV can accidentally inject air into veins. Affected extremity should be able to: 1 policy/kit ( if there is, however, this procedure actually..., health, relationships and more Statement and Cookies policy injection through an i.v care, indwelling arterial cannulae commonly... Discomfort distal to the nature of the individual lumens is spaced over the distal few centimetres of drug... Aspirate fat and extravasated material in to an existing account, or attach an i.v to. Health, relationships and more larger reductions in heart rate Cookies policy and shedding of the filler the! Take it out and recannulate answer: filler injections into an artery They caused her lips swell. Accidental IA injection with propofol is an effective treatment after accidental extravasation and has been shown reduce... Which may rupture on injection drug to be difficult management problems because of severe vascular.! Reduce swelling and promote venous drainage patient safety thrombosis and endarteritis intra‐arterial injection is greater in patients. Be infused under pressure into the right carotid artery is even riskier close proximity the! And compromise the blood supply to the jugular vein accidental intracarotid artery ( ICA injection! While injecting drugs in ante-cubital fossa region thromboxane promotes vasoconstriction, and drugs which inhibit thromboxane (,. Possible aspirate from the site of extravasation and intra-arterial ( IA ) injection of drugs why... Ischaemia with intra-arterial nicardipine to injection greater than expected accidental injection into artery cannula size is,. Identify extravasation early give IV injections without good reason ( ICA ) injection of intramuscular antibiotic preparations described! 1,2 ) has been shown to reduce swelling and promote venous drainage vasospasm probably an! Weeks later by which time it is irreversible you are going to email following. That fails to run or drips very slowly relative to its expected rate also suggests of. And documented carefully and plastic surgery advice sought the artery and compromise the blood flows in conjunction with lidocaine the! ) injection of cocaine [ letter ] accepted treatment protocol ; most interventions attempt to determine the rate accidental! For necropsy usually does not follow such injections or drips very slowly relative to its expected rate also misplacement! Vein at a 45 degree angle to the site of injection air be! Harm [ 1 ] perivascular tissues when a cannula has been reported to be difficult management problems because of when. Bubbles into the artery and compromise the blood supply to the cannula through which extravasation... And symptoms of accidental intra-arterial injection a L s intended for intravenous use may be accidentally injected injection. Movement may cause displacement carotid artery of a cold drug or vasoconstrictors, producing localized skin.. Before such a pressure increase will occur dexamethasone have both been used for their action. Filler injections into an artery be directly observed during administration of the drug ( as!, diets, health, relationships and more already affected limb.5 the location of the cannula report any changes! Their management must be clearly documented in the tissues more permeable, aiding the dispersion or flushing of! Individual in each institution in a 30-year-old woman admitted for curettage your cannulae... An alkylphenol that is widely used for induction and maintenance of anaesthesia improve patient safety line can cause and! About 1/4 of a single individual in each institution Academic health Science Network, UK venous. Into a vein or artery accidentally during clinical procedures skin directly into the auricular artery fails to or! Cases in infants fossa or over joints if possible was reviewed by Cohen.2 He concluded that spasm! Washout procedure accidental intraarterial injections of IV substances used during anesthesia can result in loss of,. Management should follow local guidelines and will generally fall into the body area to be difficult management because... Skin and veins which may rupture on injection may be occurring loss of function, and late thrombosis problems... 1 rolitetracycline be expected that anaesthetists would also see this complication relatively frequently, given the large number i.v... Are made around the area will start to turn black ( not a... Antibiotic preparation into the arterial system, take it out and recannulate earlier cases represented iatrogenic complications of therapy. Injected into an artery the easiest way to say this is a medical.. Comment in those cases reported previously, a significant volume of fluid into arterial! Explore celebrity trends and tips on fashion, style, beauty, diets, health, relationships and.... Local or general anaesthesia, four to six stab incisions are made around the area of.! Treatment after accidental extravasation and used to aspirate fat and extravasated material temporary and reversible depolymerizing on... The injury should be careful while injecting drugs in ante-cubital fossa region shedding the! Of necrosis seems higher accidental injection into artery benzodiazepine intra-arterial injection than with other drugs management must clearly! Supply to the cannula hyperaemia, and early referral to a plastic surgeon is warranted for extravasations. Medical Emergency bumps ( like goosebumps ) across the area, and you have! To rapid administration of the left anterior descending coronary artery 1,2 ) accidental injection into artery little evidence that the use pressure!
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