ArticlePatient safety in surgery2008
Unrecognized hand ischemia after intraarterial drug injection: successful management of a "near miss" event.
Article in Patient safety in surgery, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
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Who cites it
5 citing papers in PubMed, 11 citations in OpenAlex.
- Dry Gangrene of Hand Secondary to Repetitive Intravenous Drug Abuse: A Case Series.Journal of orthopaedic case reports · 2025Article
- Acute Limb Ischemia Caused by Inadvertent Arterial Drug Self-Injection: A Case Report.The American journal of case reports · 2021Article
- The incidence, significance, and management of accidental intra-arterial injection: a narrative review.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2019Article
- Overextension of nonsetting calcium hydroxide in endodontic treatment: literature review and case report.Iranian endodontic journal · 2012Article
- Local complications of pentazocine abuse: Case report and review.Industrial psychiatry journalArticle
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundComplications arising from accidental intraarterial drug injections have been described in the past. However, given the multitude of injected substances and complex pathophysiology, guidelines regarding diagnosis and management of patients with intraarterial injections remain vague. As such it remains unclear, when to expect limb ischemia and whether and for how long to monitor patients after intraarterial injections. CASE REPORT: We present the case of a "near miss event" in an i.v. drug abuser presenting to the emergency department 3 hours after injection of water dissolved zolpidem (Ambientrade mark) tablets into the right ulnar artery. Chief complaint was forearm pain. Clinical examination at the time revealed no concern for limb ischemia and patient was discharged. The patient returned unplanned 18 hours after injection with an ischemic right hand. Angiography revealed no flow in the distal ulnar artery and minimal flow in the palmar arch. Emergent intraarterial thrombolysis with Urokinase was performed and restored hand perfusion. Clinical follow-up 3 months after injury showed full recovery with regular recapillarisation and normal Allen test.
conclusionThis case report highlights the need to rigorously monitor patients with suspected intraarterial injections for potential delayed onset of limb ischemia. This is to our knowledge the first described case report of a successful revascularization after prolonged ischemia with delayed onset after zolpidem injection. We recommend close monitoring of these patients for at least 24 hours in addition to starting prophylactic anticoagulation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.