Intravenous injections

Vascular bed complications and injection consequences

Intravenous administration provides direct access to the bloodstream. The use of non-sterile needles, which frequently accompanies non-medical injection use of psychoactive substances (PAS), catastrophically increases the likelihood of systemic infection. The most severe local injuries to peripheral vessels include thrombosis and acute phlebitis. If left untreated, these pathologies can progress to the development of gangrene.

Chronic trauma to the vessel wall leads to pronounced vein sclerosis. In such patients, multiple subcutaneous hematomas and specific puncture marks (cuts, injuries) are visually determined. In addition to local reactions, the intravenous route of administration carries the maximum risk of a lethal overdose. The behavioral consequences of injection addiction often include personality degradation, pronounced emotional lability (from euphoria to severe aggression), inversion of circadian sleep rhythms, and deep social isolation.

Risk of bloodborne infections and their diagnosis

Gross violation of asepsis rules during parenteral interventions is a direct pathway for the transmission of dangerous pathogens. The main threat is posed by hepatitis B and C (HCV), the human immunodeficiency virus (HIV), and syphilis. An important clinical rule: the detection of positive serological markers for these infections in a patient should always alert the clinician to the possibility of psychoactive substance addiction.

When taking the epidemiological history, the physician must specifically look for risk factors: past surgeries (including traumatological ones), blood transfusions, and questionable dental procedures. Clinically, an acute infectious process in the liver often debuts with a powerful cytolysis syndrome — the activity of transaminases (ALT, AST) can exceed the normal range by more than 20 times. The presence of such enzymatic activity is an absolute contraindication to any elective surgical procedures. To confirm the viral nature of the lesion, PCR testing is prescribed (e.g., HCV RNA PCR) and serological markers of the acute phase of exacerbation are sought.

Algorithm of actions in case of an accidental needle-stick injury with a contaminated needle

Medical personnel face a daily risk of occupational contact with infected blood when performing intravenous injections or drawing blood samples. The high risk of infection materializes upon parenteral entry of a significant volume of biological fluid into the body (from 1 ml).

If an accidental puncture of the glove and skin occurs, the medical worker's actions are strictly regulated:

1. Immediately wash hands while still wearing gloves under running water with regular soap.
2. Thoroughly treat the surface of the gloves with a swab soaked in a skin antiseptic.
3. Carefully remove the gloves.
4. Wash hands again, making sure to use green soap.
5. Treat the wound site with an official detergent-based surgical solution.
6. Allow the blood to flow freely and slightly from the wound naturally.

Strictly prohibited: artificially squeezing or sucking blood out of the wound, as well as using aggressive irritating substances (iodine solutions, ethyl alcohol).

The incident requires strict control: an internal report is drawn up, a detailed entry is made in the Accident Logbook with the signature of the department head, and an official Industrial Accident Report (Form N-1) is issued in three copies. Blood is urgently drawn from the victim on the same day for antibodies to record the baseline serological status, and dynamic PCR monitoring is carried out 6 months later.

Indirect signs of regular non-medical injections

Patients with addiction often demonstrate anosognosia (denial of the severity of their condition) and malingering, actively concealing the facts of intravenous injections. Due to the unreliability of the objective history, diagnosis often relies on a set of indirect clinical signs:

• Somatic disorders: sharp weight loss down to severe anorexia (however, with cannabinoid use, appetite, conversely, increases).
• Autonomic status: intense hyperhidrosis, stubborn constipation (with chronic opioid use) or profuse diarrhea accompanying withdrawal syndrome.
• Ocular symptoms: pupillary reaction is extremely specific. In a state of opioid intoxication, marked miosis (sharp constriction) is observed, while with stimulants and cocaine, mydriasis (dilatation) occurs. During the drug withdrawal period, these reactions are of the opposite character.

Direct laboratory diagnostics comes down to searching for the psychoactive substances themselves and their metabolites in blood and urine. However, this method has serious limitations and is not absolutely reliable due to the legal use of certain medications in therapeutic practice.

Class and exam questions

What else to study on this topic

• Differential diagnosis of acute viral hepatitis (cytolysis markers and serology).
• Documentation of an occupational emergency situation (Form N-1 and logbooks).
• Clinical picture of withdrawal syndrome and specific pupillary reactions to psychoactive substances.
• Instrumental diagnostics of liver pathologies (ultrasound of the pancreatoduodenal zone).
• Analysis of the biochemical liver profile: distinction between cytolysis syndrome and cholestasis.

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.