cefotoxine 1G IV components. What happens if given inadvertently intra-arterial?

Question

A patient was on saline I.V. cefotoxine 1G IV was given through the I.V. The patient developed severe burning althrough the hand. Later, gangrene resulted and ten days thereafter his right thumb and right digits 1,2,3 were amputated. It is case of medical negligence. I want all details as to how inadvertent inra-arterial injection could be given, its associated symptoms and the resulting consequences.

Answer 1

The case you are describing had the medications received intravenously but the damage resulted from: either high concentration of medication given in a very rapid injection thus causes irritation of the vein, and/or due to infiltration to the tissues.Infiltration occurs when the tip of the IV catheter withdraws from the vein or pokes through the vein into surrounding tissue, or when the vein's wall becomes permeable and leaks fluid in association with patient's movement. This is very irritating to the tissue and in the case you described it got extensive damage that caused tissue death or necrosis ending up as gangrene.

The possibility of getting it intrarterial seems to be negative. First, intraarterial access is not very easy within the peripheries as arteries are a bit deeper. Second, if you inserted a cannula on the artery believing it is artery, you will immediately know because of the red gushing back blood. It will go up the IV tubings if you had connected it. Lastly, you mentioned the patient is on saline thus the patient could have aready reacted on the period receiving the solution intraarterial.

I believe the patency of the IV line is always checked before drug administration. This has been checked I am sure however it id the responsibility of the administering person (nurse) to check the site during medication administration. The high possibility I suggest id that there had been infiltration on the tissues by such medication un which became unnoticed and it caused tisue injury and compression which affected blood circulation along the periphery thus leading to tisue death or necrosis.

You want to know about the effects of inadvertent intraarterial administration of medications:
Many patients complain of immediate discomfort (often within seconds), ranging from local irritation15-19 to intense pain distal to the site of injection.20-25 Soon thereafter, many patients will report sensory problems such as tingling, burning, and paresthesias. Altered motor function (involuntary muscle contractures and muscle weakness) and cutaneous manifestations (flushing, mottling) have been reported.There will be paresthesias and pronounced hand weakness. Rapid development of signs indicative of necrosis

Within 7 to 10 days, further evidence of vascular compromise may become evident. Pulselessness, pain, cyanosis, paresthesias, pallor, and paralysis may indicate the onset of compartment syndrome. Eventually, tissue necrosis, gangrene, and permanent functional deficits develop.

Read further on the link below:
http://www.mayoclinicproceedings.com/inside.asp?AID=938&UID=

Answer 2

I'd be surprised if this were a case where the line was started intraarterial instead of intravenously. It would be very difficult to start a line in an artery. First, of all, they're usually much deeper in the tissue. Secondly, the person initiating the IV should notice some problems upon starting it - mainly a pulse, and bright red, pulsating flash in the IV cathlon.

More likely, I would say this is a case of not have a patent IV - the vein was badly damaged and leaked, or the IV cathlon was passed through the vein and into the extravascular tissue. Many drugs, when extravasated (or given outside the vein) can be quite damaging to the tissues, resulting in tissue necrosis as you have described.

If the drug adminstered was known to be damaging to tissues, the IV site should have been checked thoroughly before administering the drug by flushing with normal saline or some other isotonic crystalloid fluid. However, it is possible that the IV was established correctly, but due to patient movement or other causes beyond the control of the medical professional, it became infiltrated.

Answer 3

Hi there !

Really surprising and hard to believe...!
Because... cefotoxine is usually given itravenously...u agreed to it..right ?

The I V Drip is going on...think about such a scenario.....okay ?
If it had been intra arterial....for which chances are very very rare...it would have come to know when the drip was in-place itself ! Because as the intra-arterial pressure is higher and the arteries are deeper...and more painful....

Maybe an inexperienced staff nurse ? not a recognised hospital ? lack of expertise on the part of the staff ? not diagnosed earlier ?? as it had gone to the stage of gangrene ? maybe some other cause other than the one attributed ?

Story / Incident is hard to digest in the present medical era ?

Why dont you consult a GOOD anaesthesiologist and take a second opinion in writing ?

Best of Luck !

Answer 4

Accidental arterial infusion of a cephalosporin at typical concentration is unlikely to do any damage. Many cephalosporins can actually be given IM. While understandable with more irritating medications I am quite surprised at this sequale with a cephalosporin. Infiltration and extravastion of IV fluids is not in itself evidence of negligence, but one of several complications of IV therapy. I work in a 23 bed ICU and IV's infiltrate every day. The problem is if the infusion was not stopped when the patient reported the severe burning or other signs/symptoms of IV malfunction occurred.

Answer 5

God would be unable to be seen by potential of the human eye. yet His eternal capacity and divine character are common and clearly seen by potential of the flaws He has made. the undeniable fact that God would be unable to be seen would not recommend He would be unable to be common. yet, in case you have been to look on the order of issues as being held consistent by potential of the author, who created all issues, you are able to start to work out the God, who became into and is powerful sufficient to create this way of appealing place even nonetheless He would be unable to be seen right this moment. Now faith is the insurance of issues was hoping for, the conviction of issues not seen. For by potential of it the adult men of previous gained approval. by potential of religion you realize that the international with each and every appealing creation became into arranged by potential of the recognize God, so as that what's seen became into not produced from issues that are seen...!

Answer 6

huh...sounds too much hi-fi....only a medical exert can answer this...