Question 1 of 14

(demo test)

Inadvertent intra-arterial injection is a feared occurrence of vascular access, which often has serious consequences, including chronic paresthesias, weakness, ischemia, compartment syndrome, and gangrene. Local or diffuse spread can require extensive debridements, up to and including digital amputation. The incidence is luckily between 1 in 3000-50,000. 

Several theories attempt to explain the pathophysiology, including acute release of norepinephrine, crystallization of the injected medication in the artery, and direct cytotoxicity. Most medications are not intended for arterial injection, and can result in harm. Treatment includes direct anticoagulation, symptomatic relief, local anesthetic injection, sympathetic block, and antibiotics.

Propofol, despite the well-described pain on venous injection, does not have serious intra-arterial sequelae. The remaining medications and their classes have been demonstrated to cause ischemia, cyanosis, gangrene, necrosis, and digit/limb death.

references:

Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies