Narrow Results

Aim: To quantify and qualify the types of upper limb injuries admitted to hospital as a direct result of illicit intravenous drug use (IVDU).

Method: A retrospective case series identified all inpatient admissions for upper limb injuries as a direct result of IVDU over a two-year period. The type of injury, procedures, complications, co-morbidities, relevant investigations and other notable events during admission and follow-up were identified.

Results: Thirty-six people were admitted with upper limb injuries. Infective presentations (abscess, cellulitis, osteomyelitis, and septic arthritis) were most common. Other injuries were due to accidental intra-arterial injection, soft-tissue necrosis and compartment syndrome.

Microbiological analysis from abscesses showed a high frequency of multiple organisms, and most commonly identified Streptococci, Staphylococcus aureus, and anaerobes.

These patients had high rates of hepatitis C, malnutrition, psychiatric and behavioural co-morbidities; 77% were lost to follow-up.

Conclusion: The most common injuries from IVDU are infections, and ischaemia. High rates of concurrent medical and psychosocial co-morbidities add further challenges to effective patient care.

We report a rare case of intramedullary spinal cord abscess. The patient was operated on by surgical drainage and appropriate antibiotic therapy. Improvement was seen postoperatively. Significant changes in the presentation, management, and outcome in these more recent cases are emphasized.

Background: Intravenous access is very crucial in administration of fluids, medications and nutrition. Almost all inpatients will require it and the simplest and quickest access is peripheral with the preferred sites being either dorsum hand, radial wrist or forearm. It has its complications, of which most are avoidable. Literature has emphasised the complications and reported on preventive measures but lacks the sequelae of the complications related to peripheral intravenous devices (PIVD). We report on the sequelae of moderate-to-severe complications of these patients.

Methods: Thirty-three patients had moderate-to-severe complications related to PIVD in a tertiary centre from January 2017 to December 2017. All data were obtained from electronic medical report (EMR).

Results: Majority had extravasation (45.5%) and abscess (39.4%), whereas two patients had thrombophlebitis (6.1%) and three patients developed necrotising fasciitis (9.1%). All patients with abscess and necrotising fasciitis underwent surgical intervention (n = 16); four patients had multiple debridements. All infections were treated with empirical antibiotics and changed after culture results were obtained. Seven patients had sepsis/bacteraemia wherein two of them passed away. A total of 31 patients were discharged. Two patients had secondary suturing of the wound, one had split-thickness skin grafting (SSG) coverage and the others had daily dressing until the wound healed by secondary intention.

Conclusions: PIVD-related complications can be debilitating and may occur despite strict preventive measures. Early clinical diagnosis and prompt treatment of these complications can decrease its morbidity.

Level of Evidence: Level IV (Prognostic)