Accidental Intra-Arterial Injection during Test Dose of Injection of Benzyl Penicillin: Complications and Management—A Case Report

Abstract

An 18 years old female patient was given a test dose of Benzyl penicillin in the Antecubital Area on the right forearm by a staff nurse of the department. After the injection, the patient complained of severe pain in the right forearm distal to the injection site. This was followed by blanching of the right forearm and hand. She was immediately heparinised followed by other symptomatic treatments. After 12 hours, a bluish discoloration developed on the hand, both on dorsal and palmar aspect, sparing the thumb. This recovered with medication, except the late development of dry gangrene of the tip of distal phalanx of the little finger which got shrivelled later on. Color Doppler flow study, echocardiography, and CT angiography of the right upper limb were done. Understanding of the pathogenesis and prompt action can help in saving a limb. Education of the medical professionals involved in administering injection is necessary so that they become aware of abnormal course or anomalous anatomy of vessels of upper limb. This can help to prevent the complications.

The incidence, significance, and management of accidental intra-arterial injection: a narrative review

“…Five cases involved diazepam, four involved penicillin or its analogues, and one each involved clindamycin or paracetamol in benzyl alcohol. 9,15,17,21,[24][25][26]32,34 The typical clinical courses from these reports are shown in Table 2. Of the 11 patients in these publications, eight required amputation, two suffered from chronic pain, and one developed distal necrosis of the fingers.…”

“…Treatment with steroids has been reported in a number of case reports, always in combination with other treatment modalities, again with mixed results. 13,34 Devulapalli et al, 76 analyzed the relationship between steroid treatment and amputation rates. The steroids and their method of delivery were not stated, and the study was limited by the fact that the steroids were always administered in combination with other treatments.…”

Upper Limb Ischemia in Preterm Infant Leading to Autoamputation of Hand – a Case Report

“…They should be well trained in early detection of ischemic changes resulting due to iatrogenic injuries in the pediatric population to avoid long term chronic complications. [14] CONCLUSION Acute upper limb ischemia in pediatric population is a rare entity and is associated with auto amputation and high mortality rates. Timely, diagnosis and treatment helps in avoiding long term complications.…”