see also: [[Endocarditis]] , [[Hepatitis]], [[Buprenorphine]] - [Inadvertent Intra-Arterial Drug Injections in the Upper Extremity: Systematic Review.](bookends://sonnysoftware.com/ref/DL/270431) - [Dunn - vascular complications of IV drug use](x-devonthink-item://E3C44FD0-20E2-4FD9-A763-D0757BFB97B2) - [Dunn Illicit drug use](x-devonthink-item://D9D48F6F-51E4-4FEA-84EE-EBF68892A99C) # manufacturing risks - adulterants -- scopolamine in heroin sometimes - addditives eg strychnine, quinine, talc - # usage complications ## intra-arterial injection (trash hand) issues: thrombus, spasm, micro-emboli, pseduo-aneurysm, chemical arteritis, diffuse tissue ischaemia may develop [[Compartment syndrome]] features: - intense burning pain along distribution of artery - constant pain and mottling develops over a few hours - pallor and purplish erythema, cyanosis of digits - pulses usually present ix: - CK - renal function - vascular US - angiography - risk of limb ischaemia and tissue necrosis treatment: - not much consensus - anticoagulation usually recommended eg IV heparin 5000 IU loading then infusion - antiplatelet (eg aspirin + ticagrelor 180mg) , intra-arterial vasodilator, prostacyclin, thrombolyitics, steroids, abx - can also do catheter-directed thrombolysis - sometimes fasciotomy if compartment syndrome - amputation in 30% - elevate limb ![[Pasted image 20240915225844.png]] ## arterial false aneurysm - often aneurysmal abscess rather than just false aneurysm - most related to femoral artery, occasionally radial or brachial - due to haematoma formation within wall of vessel mgmt: - supportive - may bleed torrentially - broad spectrum abx - vascular reconstruction ## venous thrombosis and thrombophlebitis - common - a/w cellulitis also