Sciatic nerve injection injury

Kim, Hyun Jung; Park, Sang Hyun

doi:10.1177/0300060514531924

Cited by 48 publications

(46 citation statements)

References 46 publications

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“…Intramuscular injection injuries are entirely avoidable with the use of proper injection techniques 9 10. Therefore, the authors recommend safer ways to provide intramuscular injections as well as avoidance of intramuscular injections when other administration routes can be used.…”

Section: Global Health Problem Analysismentioning

confidence: 99%

“…11 Some authors have also explored administering gluteal intramuscular injections into the ventrogluteal region, commonly known as the ‘gluteal triangle’ (figure 2). 9 10 The base of the gluteal triangle is formed by a virtual line joining the anterior superior iliac spine (ASIS) and the apex is formed by the greater trochanter of the femur. Proponents of the ventrogluteal injection site argue that it is more difficult to reach the sciatic nerve with a needle in this position than with the dorsogluteal approach, but there are no known outcomes data available comparing the two techniques.…”

Section: Global Health Problem Analysismentioning

confidence: 99%

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An unfortunate injection

et al. 2016

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Intramuscular injection has been used to administer medications for more than a hundred years. However, despite our profession's long experience with intramuscular administration, preventable complications such as injection nerve palsies are still prevalent in developing countries. Injections account for one-fifth of all traumatic nerve injuries. These injuries largely occur due to indiscriminate use of intramuscular injections for treating common illnesses, frequently by unlicensed or undertrained practitioners administering unnecessary treatment to impoverished patients. The sciatic nerve is the most commonly injured, and frequently the resulting muscle weakness and associated disability are irreversible. This case report includes a video of a patient with foot drop 6 weeks after gluteal intramuscular injection. Such injuries can be prevented by proper awareness and training, the implementation of safer injection techniques, and quality assurance methods.

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Section: Global Health Problem Analysismentioning

confidence: 99%

Section: Global Health Problem Analysismentioning

confidence: 99%

An unfortunate injection

et al. 2016

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“…Sıklıkla gluteal bölgeden uygulandığından, siyatik sinir ve dallarının enjeksiyon nedeniyle iatrojenik yaralanmaları meydana gelebilmektedir (2). Aksiller ve radiyal sinirler de intramüsküler enjeksiyonlar sonucu yaralanabilmektedir ancak oldukça az rastlanmaktadır.…”

Section: Introductionunclassified

“…Nörotoksik ajanların enjeksiyonu sonrası sinirde peteşiyal hemorajiler, şişlik ve solukluk meydana geldiği, histopatolojik olarak ise myelin ve aksonda splitting ve fragmantasyon, aksoplasmin yoğunlaşması, mitokondrianın şişmesi veya myelin kılıfın total hasarı gibi aksonal değişiklikler meydana geldiği gösterilmiştir (2,5).…”

Section: Introductionunclassified

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Enjeksiyon Nöropatisi Olgularına Adli Tıbbi Yaklaşım

Ünal¹,

Ünal²,

Emir³

et al. 2015

Bull Leg Med

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ÖzetAmaç: Gereksiz enjeksiyonlar, hatalı uygulama teknikleri ve enjeksiyonların donanımsız (eğitimsiz, yetersiz) personel tarafından yapılması enjeksiyon nöropatisine neden olabilir. Bu çalışmanın amacı enjeksiyon nöropatisi vakalarının özellikleri ile nöropatiye sıklıkla n e d e n o l a n e t k i n m a d d e l e r i b e l i r l e m e k v e s i y a t i k s i n i r yaralanmalarının bir kısmının tıbbi uygulamalara bağlı olduğu göz önüne alındığında enjeksiyon nöropatisinin tıbbi uygulama kusuru olarak değerlendirilip değerlendirilemeyeceğinin tartışılmasıdır.Gereç ve Yöntem: 2008-2010 yılları arasında enjeksiyon nöropatisi iddiası ile Adli Tıp Kurumu 3. Adli Tıp İhtisas Kuruluna gönderilen dosyalar retrospektif olarak incelenmiştir. Tüm vakalarda enjekte edilen ajan, enjeksiyon yapılma nedeni, enjeksiyonu yapan kişi ve nörolojik sekelin ciddiyeti değerlendirilmiştir.Bulgular: Adli Tıp Kurumuna gönderilen 121 vakanın 107'si (%88.4) erkek, 14'ü (%11.6) kadındır. Enjeksiyonları uygulayanların büyük kısmı (n=93,%76.8) hemşire veya sağlık memurudur. En sık rastlanan etken madde diklofenak sodyumdur. Vakaların 47'sinde (%38.8) sadece diklofenak sodyum enjekte edildiği tespit edilmiş, kombine ilaçlara bakıldığında bu sayının 58 olduğu görülmüştür. Diğer yandan ise 10 vakada ağrı kesici enjekte edildiği tespit edilmiş ancak ilaçların isimleri tıbbi evrakta bildirilmemiştir. Bir vakada doktor ve hemşire enjeksiyon nedeniyle tıbben kusurlu olarak bulunmuştur.Sonuç: Enjeksiyon nöropatisinin sadece enjeksiyonun hatalı uygulanmasından değil ilaçların toksik etkisi nedeniyle oluşabildiği hayvan deneyleri ile gösterilmiştir. Enjeksiyon doğru yapılsa bile, çeşitli derecelerde nörolojik sekeller meydana gelebilir ancak enjeksiyon ajanını seçerken dikkatli davranmak ve yardımcı sağlık personelinin eğitimi ile istenmeyen etkilerin oranı azaltılabilir.Anahtar kelimeler: Enjeksiyon nöropatisi, İntramüsküler enjeksiyon, Malpraktis AbstractObjective: Redundant injections, false administration techniques and the injections applied by unqualified personnel can cause injection neuropathy. The purpose of this study is to characterize the postinjection neuropathy cases, to identify the active ingredients used for injection and, knowing the fact that the a number of sciatic nerve injuries are secondary to medical intervention, to discuss if postinjection neuropathy can be considered as malpractice.Materials and Methods: A retrospective study was conducted based on the analysis of 121 cases which were sent to the Council of Forensic Medicine from the courts with a post-injection neuropathy claim in 2008-2010. All patients were evaluated for the agent injected, indication for injection and person who injected the drug and the severity of neurodeficit.Results: It was found that 107 (88.4 %) of 121 cases sent to Council of Forensic medicine were male, 14 (11.6%) of them were female. Majority (n=93, %76.8) of the injections were applied by a nurse or health officer. Diclofenac sodium is the major injection agent. While 47 (38.8%) of the cases had ...

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Implementation of Clinical Decision Support on Emergency Department Delivery of Human Rabies Immune Globulin

et al. 2022

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IMPORTANCEFatal human rabies infections can be prevented through appropriate rabies postexposure prophylaxis (PEP). Errors in patient selection and administration of human rabies immune globulin in the emergency department (ED) setting were identified in a previous study of rabies PEP administration. OBJECTIVE To test the a priori hypothesis that implementation of a rabies PEP bundle in the ED would improve full adherence to 6 human rabies immune globulin quality indicators compared with preimplementation controls. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study was conducted in 15 EDs in a US multihospital health system. Patients who received human rabies immune globulin or rabies vaccine in the ED from January 2015 to June 2018 were included in the preimplementation control group and from December 2019 to November 2020 were included in the postimplementation intervention group. Data were analyzed in January 2021. EXPOSURE The PEP bundle was implemented in December 2019 and consisted of electronic health record enhancements, including clinical decision support, ED staff education, and patient education. MAIN OUTCOMES AND MEASURES Full adherence to 6 human rabies immune globulin quality indicators: patient selection, dose, timing, infiltration into wounds, administration distant from rabies vaccine site, and administration that avoids the buttock. RESULTS The study included 324 patients; 254 patients were in preimplementation group (mean [SD] age, 39 [21] years; 135 [53%] women) and 70 in the postimplementation group (mean [SD] age, 38 [19] years; 33 [47%] women). Most patients presented to EDs embedded in a community hospital (231 patients [71%]). Full adherence increased from 37% in the preimplementation group to 61% postimplementation (absolute increase, 24%; 95% CI, 11% to 37%; P < .001). Adherence improved for quality indicators for infiltration into wounds (137 of 254 patients [54%] to 50 of 70 patients [71%]; P = .009), administration distant from rabies vaccine site (180 of 254 [71%] to 58 of 70 [83%]; P = .04), and administration that avoids the buttock (168 of 254 [66%] to 58 of 70 [83%]; P = .007). No instances of sciatic nerve injury or compartment syndrome were observed. CONCLUSIONS AND RELEVANCE In this quality improvement study, implementation of a rabies PEP bundle was associated with improved patient selection and delivery of human rabies immune globulin in EDs across a multihospital health system. Although the bundle included ED staff education and patient discharge education, the observed improvement was likely driven by clinical (continued) Key Points Question Is implementation of a rabies postexposure prophylaxis bundle, consisting of electronic health record enhancements, staff education, and patient education, associated with improved human rabies immune globulin (HRIG) patient selection and delivery in the emergency department? Findings In this quality improvement study that included 324 patients, the primary outcome of full adherence to 6 HRIG quality indicators increased...

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Sciatic nerve injection injury

Cited by 48 publications

References 46 publications

An unfortunate injection

An unfortunate injection

Enjeksiyon Nöropatisi Olgularına Adli Tıbbi Yaklaşım

Implementation of Clinical Decision Support on Emergency Department Delivery of Human Rabies Immune Globulin

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