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Intravascular injuries from intramuscular penicillin
1Department of Clinical Investigation, William Beaumont Army Medical Center, El Paso, Texas.
Clinical Pediatrics
|February 1, 1988
Summary
Benzathine and procaine penicillin injections can cause serious injuries due to accidental intravascular administration. Minimizing use in infants and careful technique are crucial to prevent complications like Hoigne's syndrome.
Area of Science:
- Pharmacology
- Clinical Medicine
- Patient Safety
Background:
- Benzathine penicillin and procaine penicillin are opaque intramuscular injection preparations.
- Aspiration of blood is a critical safety check to prevent intravascular injection, but visualization is difficult with these opaque solutions.
Purpose of the Study:
- To highlight the risks associated with inadvertent intravascular injection of penicillin preparations.
- To identify potential complications and recommend preventative measures.
Main Methods:
- Review of potential complications arising from intramuscular penicillin injections.
- Analysis of injection-related injuries and central nervous system syndromes.
Main Results:
- Inadvertent intra-arterial injection can cause severe injuries to the gluteal region, extremities, perineum, and spinal cord, potentially due to vascular occlusion by penicillin crystals.
- Intravenous injection may lead to Hoigne's syndrome, a central nervous system reaction to procaine, with symptoms ranging from transient effects to coma, convulsions, and death.
- Infants are disproportionately affected by arterial injuries, suggesting a need to limit penicillin preparation use in this population.
Conclusions:
- Minimizing the use of benzathine and procaine penicillin in infants is recommended.
- Strict adherence to anatomical landmarks and manufacturer guidelines is essential for safe administration.
- Awareness of potential complications like Hoigne's syndrome is critical for healthcare providers.