Introduction

Intravenous injections are an everyday practice in the health-care

sector and are also frequently abused among drug abusers.

According to a 2019 report published by the Ministry of Social

Justice and Empowerment of the Government of India, India has

an estimated 8.5 lakh intravenous drug abusers [1]. A substantial

proportion of them report risky injecting practices. About half

reported reusing their needles and syringes, and about a third

reported experiencing vein-related complications, ulcers, and

Case Report

A 28-year-old male, right-hand dominant, an intravenous drug

abuser for the past 5 years, presented to the orthopedics

emergency department of our hospital with a history of pain,

redness, and swelling in his left proximal forearm from the past 2

h. The patient admitted to injecting heroin into his left proximal

forearm vein with a multiple times reused syringe and that the

needle broke while injecting the drug. Immediately, a tourniquet

was applied at the level of the midarm by the patient himself to

prevent embolization of the needle. Radiographs (AP and

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59

Dr. Saurav Jain

identify the location of the needle fragment. Wound

exploration was done after injecting local anesthesia around the

suspected injection site (Fig. 2a), and an intact, slightly bent

needle was seen in a superficial vein lumen (Fig. 2b). The

needle was removed (Fig. 2c), and the damaged venous

including the heart and the lung [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,

13, 14, 15, 16, 17, 18]. There is not much literature that can be

found on the successful retrieval of the needle at the injection

site in intravenous drug abusers [14].

There is a lack of specific guidelines for needle retrieval.

Leaving a needle as such can cause abscess formation [14] at

the local site and, in extreme cases, can lead to endocarditis [8]

and purulent pericarditis when embolized [10]. An attempt at

removing the needle itself can sometimes lead to proximal

migration of the needle during manipulation [4]. We strongly

the needle breakage. Early presentation makes the retrieval less

complicated for the treating surgeon, as was the case with us.

Late presentation risks the broken needle migrating in the

body. Another critical point to highlight is the early application

of a tourniquet by the patient himself immediately after the

needle breakage, which prevented the proximal migration of

the needle. Tourniquet use has been reported to be

unsuccessful when applied late [4, 14].

Conclusion

Intraluminal intravenous needle breakage should be dealt with

61

1. Ambekar A, Agrawal A, Rao R, Mishra AK, Khandelwal

SK, Chadda RK. Magnitude of Substance use in India. New

D e l h i : A I I M S ; 2 0 1 9 . A v a i l a b l e f r o m :

https://www.aiims.edu/en/national-drug-use-survey-

2019.html [Last accessed on 2023 Jan 28].

2. Angelos MG, Sheets CA, Zych PR. Needle emboli to lung

Emerg Med 1988;6:124-7.

5. Gyrtrup HJ, Andreassen KH, Pedersen JH, Mortensen LB.

Central embolization of needle fragment following intravenous

drug abuse. Br J Addict 1989;84:103-5.

6. Kulaylat MN, Barakat N, Stephan RN, Gutierrez I.

Embolization of illicit needle fragments. J Emerg Med

1993;11:403-8.

7. LeMaire SA, Wall MJ Jr., Mattox KL. Needle embolus

causing cardiac puncture and chronic constrictive pericarditis.

Ann Thorac Surg 1998;65:1786-7.