Acute ischemia of the hand following intra-arterial oxymetazoline injection

Acute ischemia of the hand following intra-arterial injection of a drug is an infrequent problem, but it requires urgent medical attention. In this report, a patient injected a nasal decongestant, oxymetazoline hydrochloride (Afrin), into his radial artery. This resulted in severe burning pain, and cyanotic, cold, and pulseless hand, suggestive of acute ischemia. Intra-arterial papaverine, nifedipine, anticoagulation with heparin, prednisone, and stellate ganglion block did not improve the hand circulation. Development of gangrene necessitated a disarticulation at the wrist joint. Diagnosis, complications, and therapeutic measures of acute hand ischemia secondary to intra-arterial drug injection are discussed.