True mycotic aneurysms develop when there is disruption of the arterial wall due to infectious arteritis rather than as a result of direct vessel wall trauma 31. They may occur in PWID locally at injection sites or in distant arteries due to haematogenous seeding. The aorta is the most commonly affected vessel followed by the femoral artery 31. The majority of cases of mycotic aneurysms occur in PWID or after invasive endovascular or surgical procedures.

It’s about playing the long game, ensuring that today’s problem doesn’t become tomorrow’s crisis. For common complications like infiltration or phlebitis, immediate interventions often involve removing the IV and applying appropriate treatments to the affected area. As with many things in life, prevention is better than cure when it comes to IV therapy complications. It’s like building a fortress to protect against invaders—the stronger your defenses, the less likely you are to face problems. It’s like being a detective, but instead of solving crimes, you’re preventing medical mishaps.

An Ounce of Prevention: Strategies to Minimize IV Risks

• It’s like being a detective, but instead of solving crimes, you’re preventing medical mishaps.
• In PWID, abscesses may develop in deep locations due to direct extension from the site of injection, such as from the groin into the pelvis or retroperitoneum, or as a result of haematogenous seeding of distant locations.
• From the IV solution itself to the catheter material, there are plenty of potential allergens lurking in IV therapy.
• These diseases can require lifelong treatment, and IV drug users can unknowingly spread these diseases to others.
• All complaints and concerns are fully investigated by corporate compliance and corrective actions are implemented based on substantiated allegations.

If the patient is unable to give a history due to instability, AMS, or some other reason, history should be elicited through any companions, EMS, telephone contacts and/or through chart review. Play close attention to the airway in those with potential SSTIs in the neck area, as the practice of the “pocket-shot” can lead to infection in the carotid triangle and result in airway obstruction or laryngeal edema (6). Other causes of AMS or neurological abnormalities in PWID include septic emboli to CNS from endocarditis, mycotic aneurysms, and delayed leukoencephalopathy (6). Cocaine and amphetamines are 2 well-known drugs that can cause hyperthermia.

Human Immunodeficiency Virus (HIV)

Bone marrow oedema is the earliest imaging finding identifiable in acute osteomyelitis and appears on MRI as high T2 and STIR signal intensity of the bone with corresponding low T1 signal (Figs. 10 and 11) 17, 18. High T2/STIR signal without low T1 signal is less specific and may represent reactive osteitis rather than osteomyelitis 17. Cortical bone destruction can be identified as loss of the normal peripheral T1 hypointense cortical rim. Assessment of the extent of the infection in adjacent soft tissues, differentiation of bone from soft tissue infection and surgical planning can also be reliably achieved on MRI (Fig. 12) 17, 18. Plain radiographs may show indirect signs of cellulitis such as soft tissue swelling and loss of fascial planes and can identify radio-opaque retained foreign bodies. Ultrasound features of cellulitis include diffuse thickening and increased echogenicity of subcutaneous tissues and a characteristic “cobblestone” appearance of the subcutaneous fat due to soft tissue oedema 8, 9.

The “imaging psoas sign”, high T2 signal within the psoas musculature, is also suggestive of discitis/osteomyelitis in suspected spinal infection 21. An important differential to consider are Modic type 1 changes which are presumed part of the spectrum of endplate signal abnormalities seen in degenerative disease 20. Modic type 1 changes are considered acute/subacute and also cause low T1 and high T2 endplate signal intensity. Signal within the intervening disc is typically low, however, in contrast with the high signal seen in discitis 20. Surrounding soft tissue inflammatory change, including the “imaging psoas sign”, and clinical history indicating an increased risk of haematogenous infection, as in PWID, also suggest a diagnosis of discitis 21.

Skin Ulcers

• But like any powerful tool, it comes with its share of potential pitfalls.
• Based on the clinical features and exam, also consider CT with contrast to investigate suspected NSTIs (44), or contrast CT or ultrasound for suspected pseudoaneurysm (6).
• Of those with septic arthritis, common pathogens include Staphylococcus species (including MRSA), Streptococcus, Pseudomonas, and Serratia species (37).
• Osteomyelitis due to haematogenous spread tends to result in a slow, insidious progression of symptoms whereas osteomyelitis from direct local extension presents with more pronounced and aggressive local manifestations.

Cellulitis, in particular, is a common IV site infection in drug users. One study found that 32% of injection drug users in a neighborhood in California currently had abscesses, cellulitis, or both.1 If left untreated, cellulitis can become serious. Intravenous drug users can be challenging patients to manage on medical wards, with aggressive behaviour, illicit drug use while in hospital and early self-discharge commonly encountered. Hepatitis C can either be chronic but asymptomatic (without symptoms, which means you barely even notice you have it), or chronic-active, which means disease will develop over a long period of time–several years or perhaps even decades.

• Septic arthritis is a painful infection that can cause extreme discomfort and limit the mobility of the infected joint and surrounding area.
• MRI protocols typically include sagittal T1, T2, STIR and contrast-enhanced imaging of the affected segment of the spine in addition to axial T2 and contrast-enhanced imaging at levels noted to be abnormal on initial sagittal sequences 20.
• If not diagnosed with HIV, consider testing for HIV because of the close association between intravenous drug use and HIV transmission.
• While there are many bacteria and even fungi that can cause cellulitis, most cases result from group A Streptococcal bacteria.

Transmission of infectious diseases

Diffusion-weighted imaging (DWI) may be added in certain cases, such as to assess for abscess formation. Fat-saturated T2 or enhanced T1 sequences can be used to improve the delineation of inflammation. A gradient echo sequence may be added in more severe cases with suspected haemorrhage or necrotising fasciitis. In cellulitis, high T2 and STIR signal intensity with corresponding T1 signal intensity of the subcutaneous tissues with overlying skin Sober living home thickening is seen, and there is enhancement following gadolinium administration 8.

The Double-Edged Sword of IV Therapy

In a similar study performed by Chotai et al.,4 patients in the IVDU cohort tended to be smokers and unemployed, with a significant medical history for hepatitis C and other mental health disorders. This study examines the differences in demographics and treatment factors related to upper extremity infections in IV drug users compared with non-IV drug users. The number of patients presenting to our emergency room with an IVDU-related upper extremity infection more than doubled in 10 years, and our rate of upper extremity infections related to IVDU rose to 10.3% in 2015 (up from 5.2% in 2005 to 6.3% in 2010). The magnetic resonance imaging (MRI) sequences employed in suspected soft tissue infection will typically include T2, a fluid-sensitive sequence such as short-tau inversion recovery (STIR) and unenhanced and post-contrast T1.

Septic Thrombophlebitis

This puts these patients at risk for epidural and subdural hematomas, as well as other forms of intracranial hemorrhage and TBI’s. Only a professional can diagnose a substance use disorder and prescribe medication that may encourage long-term healing. Consulting with your primary care physician or a mental health professional is a good place to start when you decide to get help.

Infective bone and joint complications in PWID may originate from direct extension of infection from injection sites in adjacent soft tissues or, more commonly, due to bacteraemia and haematogenous seeding 16. In adults, haematogenous spread most frequently involves the spine leading to discitis and osteomyelitis. The risk of infective complications in PWID is also often increased as a result of co-existing immunosuppression due to chronic viral infections or cirrhosis.

This addiction typically involves the injection of drugs directly into the bloodstream using needles and syringes, which allows for rapid drug delivery and intense effects. IV addiction can encompass a variety of substances, including but not limited to opioids, stimulants, sedatives, and other drugs. To account for this, we manually reviewed patient medical records with a mention of IVDU or synonyms in any report to confirm that patients in fact presented with an upper extremity infection, and to determine the presence or absence of IV drug use. Second, this study represents the population at one academic medical center in the Northeast United States, and some results may not be generalizable to other geographic regions and metropolitan areas. Fourth, due to the retrospective nature of this study, we cannot comment on patients who sought care at another institution after receiving initial treatment at our facility. Fifth, the reasons for more IVDU infections are not explored in this study.

Public Health Problems Related to IV Drug Use

Our team takes a compassionate approach to treatments and is there to help patients along their sobriety journeys. Those with HIV may not develop symptoms immediately or assume they may just have a cold or flu. As HIV progresses, it may cause irritated, flakey skin, shingles, oral thrush and significant weight loss. Latency in HIV can last as long as 10 to 15 years, preventing people from receiving a proper medical diagnosis if they are asymptomatic. A potential overdose needs to be addressed and treated immediately by a medical professional.

• IV drug use involves introducing a drug directly into the bloodstream through a needle.
• According to CDC data from 2014, 27 million people aged 12 or older tried drugs in the last 30 days, about 1 in 10 Americans (3).
• This study was approved by our institutional review board and granted a waiver of informed consent for this retrospective chart review.
• Osteomyelitis as a result of local soft tissue infection may involve any bone, commonly affecting bones close to injection sites such as the extremities and pelvis in PWID.

Clinical Procedures for Safer Patient Care

In adults, haematogenous osteomyelitis typically involves the spine and is rare at other sites 17. Osteomyelitis as a result of local soft tissue infection may involve any bone, commonly affecting bones close to injection sites such as the extremities and pelvis in PWID. MRI is, therefore, the imaging modality of choice for the acute diagnosis, similar to osteomyelitis elsewhere in the body. MRI protocols typically include sagittal T1, T2, STIR and contrast-enhanced imaging of the affected segment of the spine in addition to axial T2 and contrast-enhanced imaging at levels noted to be abnormal on initial sagittal sequences 20. MRI demonstrates high signal intensity in the intervertebral disc space on T2 images with corresponding low signal on T1 (Fig. 13).

Table 7.11 Areas for Improvement to Prevent IV Medication Errors

Continual injections at the same site can cause scarring, bruising and even vein collapse. With continual intravenous injections through the same vein, the vein’s internal lining may become inflamed and collapse. A collapsed vein can no longer function properly, and blood does not travel through this vein anymore. Although infections in IDUs can be challenging to manage, they can be satisfying to look after with the right approach. Skin and soft-tissue infections and complications of bacteraemia remain common, but outbreaks of rare infections do occur, so it is essential to remain alert for severe or unusual presentations. Scar tissue can develop in the limbs, and the risk for skin abscesses and infection are high.

• CT is also important in the evaluation of sites such as the sacroiliac or sternoclavicular joints where plain film assessment is limited 24.
• Contiguous spread from SSTIs, direct inoculation, and hematogenous spread may result in septic arthritis or osteomyelitis in PWID (37).
• Protocols and force functioning need to be developed to minimize potential errors and to identify potential gaps in the system process.
• Important alternative causes of bone and joint infections to consider at the outset include recent trauma, recent surgery or joint instrumentation, or previous intervention involving insertion of fixation hardware or prostheses.
• Along with skin infections, IV drug use can also lead to blood infections.

Proper circulation is necessary to the body’s ability to heal a wound, such as an injection wound. Without adequate blood flow, the injury is unable to heal properly and can turn into an ulcer. Additional complications may include nerve or tissue damage, medication being absorbed too fast or too slow, wrong location for the medication (i.e., heparin given IM instead of SC), pain, bleeding, or a sterile abscess (Perry et al., 20148. Sharing needles or cookers puts IV drug users at risk for contracting HIV, the virus which causes AIDS.

IV drug use often causes more intense highs, making it difficult for someone to gauge how much of a drug they have taken. Research has shown the number of Americans who reported using heroin in the last year has been increasing each year since 2007. In addition to heroin, other common IV drugs include Talwin, fentanyl, buprenorphine and hydrocodone. We’ve got some tips for people who use drugs to access healthcare and advocate for yourself with healthcare providers – check out Quality Healthcare Is Your Right resource. Track marks are the scars that appear along the veins of someone who injects alcoholism symptoms frequently and repeatedly uses the same  injection sites.

• Arterial pseudoaneurysms have a characteristic appearance on ultrasound which demonstrates an anechoic collection adjacent to the artery containing turbulent flow which appears as the “yin-yang sign” (Fig. 17) on Doppler ultrasound 28.
• Be wary of PWID who do not appear to metabolize and recover their mentation as expected and in those with signs of trauma and/or focal neurological deficits.
• The immune system causes swelling to develop, and pus is created from the combination of white blood cells, germs and damaged tissues.
• Administration of drugs by injection poses multiple additional health risks when compared to other methods of consumption.
• In the IVDU cohort, 87 subjects were male (59%) and 130 (92%) were white.

IVDU patients trended toward more complex procedures such as amputation and flap coverage of open wounds, which may be a significant finding in a larger cohort. Finally, IVDU patients had overall longer hospital admissions and were more likely to require discharge to a rehabilitation facility. The incidence of IVDU cases presenting to the emergency department of a single urban center with an upper extremity infection in 2005, 2010, and 2015. The number of IVDU cases presenting to the emergency department of a single urban center with an upper extremity infection in 2005, 2010, and 2015.

Assistance for persons who use drugs

Vascular complications may manifest as injury to the vessel wall, interruption of blood flow in the lumen with resultant ischaemia or haematogenous spread of a pathogen from the injection site. Osteomyelitis is defined as bone inflammation caused by an infectious process and may be acute or chronic 17. It is often difficult to diagnose in the acute setting and can rapidly progress to a destructive process leading to significant long-term disability and pain.