• Abdul Malik cardiovascular unit lady reading hospital peshawar
  • Ikram ullah junior registrar cardiovascular lady reading hospital peshawar
  • Muhammad Gibran Khan cardiovascular LRH peshawar
  • Syed Murad ali Shah cardiovascular unit LRH peshawar
  • Muhammad Ilyas DHQ timergara


Background: Accidental intra-arterial drug injections usually occur as an iatrogenic complication but it is also found in drug abusers as a result of attempted intravenous (IV) injections. It is estimated that accidental intra-arterial injections are found in 1:3500–1:56000 patients visiting emergency department. Methods: This was cross sectional study performed in cardiovascular department Lady reading Hospital Peshawar from 1.1.2013 to 31.8.2015. Accidental intra-arterial injection was defined as intravenous injection in upper limb for any illness which is followed by sudden severe pain in limb followed by bluish discoloration of any part of limb. Data was analysed using spss-20. Frequency and percentage were calculated for categorical variables like while Means±SD was calculated for numerical variables. Chi square test was used to compare Categorical variables. Results: Total 30 patients were studied in whom 17 were male. Mean age of the study population was 43.2±17.9 years. All patients after admission were put on intravenous Heparin alone or in combination with Dexamethason, Beraprost and Nifedifin on discretion of visiting consultant. Injection diclofenac were found more frequently as cause of limb ischemia (43 %). Amputation of digits or part of limb was noted in 7 (23.1 %) cases. Conclusion: Accidental intra-arterial injection can lead to limb ischemia and even limb loss so while injecting IV drugs, care should be taken to use venous site away from arterial sites.Keywords: Intramuscular; Intraarterial; Heparin; Diclofenac; IV; IM; ABI 

Author Biographies

Abdul Malik, cardiovascular unit lady reading hospital peshawar

associate professor cardiovascular lady reading hospital peshawar

Ikram ullah, junior registrar cardiovascular lady reading hospital peshawar

junior registrar cardio vascular lady reading hospital peshawar

Muhammad Gibran Khan, cardiovascular LRH peshawar

Medical officer cardiovascular LRH peshawar

Syed Murad ali Shah, cardiovascular unit LRH peshawar

assistant professor cardiovascular ward LRH peshwar

Muhammad Ilyas, DHQ timergara

medical officer DHQ timergara


Charney MA, Stern PJ. Digital ischemia in clandestine intravenous drug users. J Hand Surg Am 1991;16(2):308–10.

Righini M, Angellillo-Scherrer A, Gueddi S, Le Gal G, Bounameaux H. Management of severe ischemia of the hand following intra-arterial injection. Thromb Haemost 2005;94(1):219–21.

Sen S, Chini EN, Brown MJ. Complications after unintentional intra-arterial injection of drugs: risks, outcomes, and management strategies. Mayo Clin Proc 2005;80(6):783–95.

Rautio R, Keski-Nisula L. Inadvertent intra-arterial drug injections: the role of angiographic and clinical findings. Acta Radiol 2006;47(6):554–8.

Cohen SM. Accidental intra-arterial injection of drugs. Lancet 1948;2(6523):361

Samanta S, Samanta S. Accidental intra-arterial injection of diclofenac sodium and their consequences: report of two cases. Anaesth Pain Intensive Care 2013;17(1):101–2.

Hudson DA, Duminy F. Microembolectomy in the treatment of arterial occlusion of the hand: report of two cases. J Hand Surg 1996;21(5):884–7.

Van der Post C. Report of a case of mistaken injection of pentothal sodium into an aberrant ulnar artery. Anesth Analg 1942;21(3):58–9.

McLean CR, Cheng KS, Clifton MA. Fatal case of accidental intraarterial phenytoin injection. Eur J Vasc Endovasc Surg 2002;23(4):378–9.

Gaspar MR, Hare RR. Gangrene due to intra-arterial injection of drugs by drug addicts. Surgery 1972;72(4):573–7

Benitez PR, Newell MA. Vascular trauma in drug abuse: patterns of injury. Ann Vasc Surg 1986;1(2):175–81.

Stonebridge PA, Callam MJ, Farouk M, Murie JA. Intra-arterial injection of oral medication in HIV positive drug addicts. Br J Surg 1990;77(3):333–4.

Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma 2004;56(6):1261–5.

Langholz J, Ladleif M, Blank B, Heidrich H, Behrendt C. Colour coded duplex sonography in ischemic finger artery disease- a comparison with hand arteriography. Vasa 1997;26(2):85–90.

Arquilla B, Gupta R, Gernshiemer J, Fischer M. Acute arterial spasm in an extremity caused by inadvertent intra-arterial injection successfully treated in the emergency department. J Emerg Med 2000;19(2):139–43.

Gouny P, Gaitz JP, Vayssairat M. Acute hand ischemia secondary to intraarterial buprenorphine injection: treatment with iloprost and dextran-40 – a case report. Angiology 1999;50(7):605–6.

Comerota AJ, White JV, Grosh JD. Intraoperative intra-arterial thrombolytic therapy for salvage of limbs in patients with distal arterial thrombosis. Surg Gynecol Obstet 1989;169(4):283–9.

Kretz JG, Weiss E, Limuris A, Eisenmann B, Greff D, Kieny R. Arterial emboli of the upper extremity: a persisting problem. J Cardiovasc Surg (Torino) 1984;25(3):233–5.

Zeller T, Frank U, Burgelin K, Sinn L, Horn B, Schwarzwalder U, et al. Treatment of acute embolic occlusions of the subclavian and axillary arteries using a rotational thrombectomy device. Vasa 2003;32(2):111–6.

Chang MY, Lin JL. Irreversible ischemic hand following intraarterial injection of zolpidem powder. J Toxicol Clin Toxicol 2003;41(7):1025–8.

Kumar M, Singh J, Sharma P, Khera A, Singh P. Accidental intra-arterial injection of diclofenac -case report. J Clin Diagn Res 2015;9(1);16–7.

Hager DL, Wilson JN. Gangrene of the hand following intra-arterial injection. Arch Surg 1967;94(1):86–9.

Mostafavi H, Samimi M. Accidental intra-arterial injection of promethazine HCl during general anaesthesia: Report of a case. Anesthesiology 1971;35(6):645–6.

Samuel I, Bishop CC, Jamieson CW. Accidental intra-arterial drug injection successfully treated with iloprost. Eur J Vasc Surg 1993;7(1):93–4.

Andreev A, Kavrakov T, Petkov D, Penkov P. Severe acute hand ischemia following an accidental intraarterial drug injection, successfully treated with thrombolysis and intraarterial iloprost infusion: case report. Angiology 1995;46(10):963–7.

Zachary LS, Smith DJ Jr, Heggers JP, Robson MC, Boertman JA, Niu XT, et al. The role of thromboxane in experimental inadvertent intra-arterial drug injections. J Hand Surg Am 1987;12(2):240–5.

Enloe G, Sylvester M, Morris LE. Hazards of intra-arterial injection of hydroxyzine. Can Anaesth Soc J 1969;16(5):425–8.



Most read articles by the same author(s)