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Robert J. Wilson, Samuel N. Crosby, and also Donald H. Lee

Robert J. Wilson

Vanderbilt University medical Center, Vanderbilt Orthopaedic Institute, 3200 MCE S Tower, Suite 3200, Nashville, TN 37232-8828 USA


Samuel N. Crosby

Vanderbilt University clinical Center, Vanderbilt Orthopaedic Institute, 3200 MCE S Tower, Suite 3200, Nashville, TN 37232-8828 USA


Donald H. Lee

Vanderbilt University medical Center, Vanderbilt Orthopaedic Institute, 3200 MCE S Tower, Suite 3200, Nashville, TN 37232-8828 USA


Vanderbilt University medical Center, Vanderbilt Orthopaedic Institute, 3200 MCE S Tower, Suite 3200, Nashville, TN 37232-8828 USA
Corresponding author.

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Introduction

In the joined States, the population who report intravenous drug usage is little but this actions is associated with dangerous and also costly health and wellness problems. According to the nationwide Survey on medicine Use and also Health (NSDUH) 2009 Report, data indigenous 2006 come 2008 confirmed that an typical of 425,000 human being annually aged 12 or older (0.17 %) supplied a needle to inject heroin, cocaine, methamphetamine or other stimulants <1>. However, within this group, actions with far-ranging medical implications were rather frequent. The report uncovered that only 29 % of individuals reported clean the needle with bleach before their last injection and 13 % of users used a needle they knew or suspected had actually been used prior to by us or an additional person <1>. The complications from intravenous medicine use and its linked high-risk behaviors can be far-ranging and incorporate local infection, endocarditis, sepsis, human immunodeficiency virus transmission, hepatitis C transmission, medicine overdose and also even death. An additional complication that intravenous drug use is needle not correct with preserved needle fragment(s). This is an especially concerning when the needle fragment is intravascular due to the possibility of succeeding embolization the the fragment to far-off sites. Us report the situation of a young woman through a kept needle fragment inside the lumen of a proximal forearm vein 7 days ~ attempted intravenous injection through Oxycodone. To our knowledge, this is the very first successful neighborhood removal the a preserved intravenous needle fragment report in the literature.


Case Report

A 30 year old right-handed female with a known history of intravenous drug abuse (IVDA) gift to the emergency department with a 5 day background of erythema, swelling and pain in her left proximal forearm, the dorsum of she left foot and her ideal jaw. She was febrile to 38.3 °C and also her heart rate on arrival was 103 beats per minute. She was uncovered to have actually a periodontal abscess and superficial abscesses in her left proximal forearm and also on the dorsum of her left foot. She admitted to injecting Oxycodone into both she left foot and also her left proximal forearm through an insulin needle. The abscesses in the left foot and also left proximal forearm underwent bedside incision and drainage. Both the proximal forearm and dorsal foot abscesses eventually grew Methicillin- resistant Staphylococcus Aureus.

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Upon drainage of the proximal forearm abscess the patient stated she was came to she may have actually a preserved needle there from an injection attempt seven days prior. X-rays of the left forearm (Figs. 1 and also ​and2)2) evidenced the visibility of a needle at the level the the elbow joint, proximal come the abscess site. X-rays of she left foot revealed no international bodies. The patience was required to the operation room the adhering to day for expedition of her wound (Fig. 3) and also removal that the foreign body. A non-sterile tourniquet was applied at the mid part of the arm and was inflated to 250 mmHg from the start of the case until the retrieval that the needle. ~ above initial gun investigation, the needle was no visible in the soft tissues. Intraoperative fluoroscopy was used and confirmed the proximal migrate of the needle throughout the procedure. The needle to be localized come a vein in ~ the level the the elbow utilizing fluoroscopy, and also a totally intact insulin needle to be extracted from within the lumen (Fig. 4). The needle to be removed and also the damaged venous segment to be suture ligated and resected. Further inspection revealed that the needle was considerably smaller when compared to a tuberculin needle (Fig. 5).