[Fingers necrosis after an accidental intra-arterial injection of flucloxacilline: case report].
Accidental intra-arterial injection of drugs is rare in pediatric patients. It is a source of considerable morbidity. Vessel proximity, aberrant vasculature, difficult procedures, and clerical errors can contribute to accidental intra-arterial injection. We report a case of a 7-year-old girl who had an accidental intra-arterial injection of 500 mg of floxacillin in her right elbow for open wound of the index. Initial signs and symptoms consisted of intense forearm pain and cyanosis. Two to 3 hours later, discoloration and nail bed pallor became evident, with no radial pulse. Rapid development of signs of acute ischemia prompted urgent brachial artery embolectomy and exploration and forearm fasciotomy. Postoperative heparin was administered. Postoperatively gangrene of the five fingers of the right hand developed. We present a comprehensive review of literature, highlighting available information on symptoms, pathogenesis, sequelae and management strategies for accidental intra-arterial injection. We believe that all physicians and ancillary personnel who administer intravenous therapy should be aware of this serious risk.
Service de chirurgie pédiatrique A, CHU Mohammed VI, faculté de médecine et de pharmacie, université Cadi Ayyad, Marrakech, Maroc. elmohtadi@yahoo.com
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Aghoutane
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Fezzazi
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Elhaouati
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Boumzebra
D000059:Accidents; D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001916:Brachial Artery / Q000473:pathology; D002648:Child; D005260:Female; D005385:Fingers / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D005436:Floxacillin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007269:Injections, Intra-Arterial / Q000009:adverse effects*; D008508:Medication Errors; D009336:Necrosis / Q000209:etiology; D010146:Pain / Q000209:etiology; D017131:Thrombectomy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005436:Floxacillin