Inadvertent Intraarterial Drug Injection Causing Digital Ischemia, A Case Report

A 33-year-old female with IV drug use disorder presented to an urgent care clinic with a chief complaint of discoloration and decreased sensation to the right index finger. She reported multiple fentanyl injections, over an eight day period, into what she thought was a vein, near the anatomical location of the radial artery. The urgent care nurse practitioner discussed the patient’s case via telephone with an orthopedic hand surgeon, who recommended the patient be seen immediately at the local Emergency Room for further evaluation and treatment. The patient presented to the ER the same day. Vascular surgery recommendations included the following: initiate a heparin infusion, obtain blood cultures, then cover empirically for infection. The patient was admitted to medicine for vascular compromise of the right index finger and sepsis secondary to cellulitis with suspected bacteremia vs endocarditis. In just three days, the patient’s physical exam was notable for improved color of the right index finger, as well as resolution of the light touch sensation deficit, allowing for hospital discharge with outpatient management.