Clinical communication
Acute arterial spasm in an extremity caused by inadvertent intra-arterial injection successfully treated in the Emergency Department

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Abstract

We present a case of limb ischemia in a young man. For acute alcohol withdrawal, this patient was given chlordiazepoxide (Librium) through an angiocatheter inadvertently placed into a brachial arterial line. This caused severe spasm of the brachial artery and its branches. These findings were con- firmed by angiography. Successful treatment occurred with intra-arterial papaverin.

Introduction

Acute ischemia of the upper extremity after intra-arterial drug injection is rare. Its treatment is frequently unsuccessful, and its prognosis is usually poor, often leading to gangrene (1). This complication is rarely seen iatrogenically and is most frequently seen in intravenous (i.v.) drug abusers (2). We report a case of acute ischemia of an upper extremity secondary to iatrogenic intra-arterial drug administration.

Section snippets

Case report

A 20-year-old male originally presented to an outlying hospital with a chief complaint of feeling “shaky.” The past medical history was significant for alcohol abuse and asthma. The patient denied any past surgical history, allergies, and i.v. drug use. The physical examination revealed a thin, poorly nourished, slightly tremulous individual with vital signs as follows: blood pressure of 120/86 mmHg, pulse of 105 beats/min, respirations of 16 breaths/min, and a temperature of 37°C. The

Discussion

Insertion of angiocatheters for venous access is a common practice. This access can be difficult, and arteries can inadvertently be cannulated. The most common sites for the placement of i.v. lines are the veins of the hands and arms, and the most common vein used is the median basilic vein in the antecubital fossa. This vein lies over the median nerve and the brachial artery, and therefore, injury to these two structures can occur (3). The cannulation of the brachial artery leading to spasm

Conclusion

Inadvertent injection of medication intra-arterially rather then intravenously may cause severe vasoconstriction leading to limb ischemia and even gangrene. Therefore, prior to the injection of a potentially limb-threatening medication, including benzodiazepines, one must be certain that the line is an i.v. and not an intra-arterial line. If inadvertent intra-arterial injection does occur, leading to limb ischemia, based on our case report, intra-arterial injection of papaverin will be

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