SAQ 181 – Vascular and Toxicology – inadvertent intra-arterial drug injection

Question 6. inadvertent intra-arterial drug injection.

a. Diagnosis

• Inadvertent intra-arterial drug injection, or trash hand.

b. Supporting findings

• Proximal extension to the cubital fossa, a common site of vascular access.
• Reticular erythematous-purple discolouration in the radial artery distribution.
• Sparing of the ulnar aspect of the hand.

c. Investigations

• Creatine kinase.
• Urea and electrolytes.
• Vascular ultrasound.
• Angiography.

d. Definitive treatment options

• IV heparin.
• Intra-arterial vasodilator such as glyceryl trinitrate.
• Intra-arterial prostacyclin.
• Intra-arterial thrombolysis.
• Reconstructive vascular surgery.
• Amputation.