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An abscess after an injection is a complication that occurs after intramuscular or intravenous administration of a drug. As a result of infection of the skin and muscles, a purulent focus appears at the injection site. It is important to differentiate between an abscess that occurs after an injection and a cellulitis. With an abscess, the purulent focus has a limited localization, a well-defined border that separates it from healthy tissue. With phlegmon, this border is blurred, the area of uXNUMXbuXNUMXbinflammation is much larger.
Causes of pathology
The main reason for the appearance of an abscess after an injection is a gross violation of the rules of antiseptics.
Ways of introduction of infection into the tissues of the human body:
Insufficiently well treated hands of medical staff;
Non-sterile consumables used for injection (syringe, injected drug, wipes);
The patient’s skin is not well treated before and after the administration of the drug.
As a result of safety violations during injection, serious complications occur.
Etiological causes of abscess formation:
Violation of the injection technique – the use of an insulin syringe for intramuscular injection, insufficiently deep insertion of the needle (it is necessary to insert the needle at least 2/3 of its length);
Violation of the rules for the administration of drugs, for example, intramuscular administration of a drug intended for intravenous infusion or subcutaneous administration. Due to such a gross error, the preparations not only do not dissolve, but also form an aseptic or infectious infiltrate.
High concentration of injections in one place with a long course of treatment;
Thick layer of subcutaneous fat in obese patients;
Prolonged administration of drugs that exhibit an irritant effect (magnesium sulfate, antibacterial agents);
Formation of a hematoma due to the needle entering capillaries and larger vessels;
Scratching the itchy injection area with the patient’s hands;
The presence of purulent skin or autoimmune diseases;
Allergy history;
Reduced immunity in HIV-infected people, in the elderly.
The most common localization of abscesses after an injection
Since most injections are performed in the gluteal muscle, which has a developed fatty layer, it is in it that a significant number of abscesses are formed. Adipose tissue is the most favorable environment for an increase in the colonies of microbes that have entered it.
Another area in which post-injection abscesses often form is the anterior or lateral surface of the thigh. It is into it that patients who are forced to inject themselves with medicine are injected.
Symptoms and manifestations of an abscess after an injection
The deeper the abscess formed, the less visual symptoms of inflammation appear. However, pain during mechanical action on the inflamed area can be very strong.
Post-injection abscess is characterized by classic symptoms of an inflammatory process, complicated by the formation of pus.
Local manifestations | Common signs of inflammation |
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The development of an abscess and fistulas are the last stages of the inflammatory process. Before purulent fusion of tissues occurs, an infiltrate is formed. If its treatment is started in a timely manner, in many cases it is possible to avoid the formation of a widespread purulent focus.
The more pronounced the purulent process, the more severe the symptoms of intoxication, since a large amount of toxins enter the bloodstream.
Complications of a gluteal abscess
A distinctive feature of the post-injection abscess is the formation of a special capsule (pyogenic membrane) around the infiltrate. Due to this, the inflammatory process is limited to its space, not spreading to healthy tissue. Excessive accumulation of pus and the resulting pressure on the tissues in advanced cases leads to rupture of the capsule shell. The consequence of this is the spread of pus into the interstitial structures, into the muscles and the space between them. An extensive phlegmon, external and internal fistulas are formed.
Phlegmon is formed more often than other complications. In complicated cases, sepsis (blood poisoning) and poliomyelitis develop.
Diagnostics
To make a diagnosis, in many cases, the doctor suffices with data from a visual examination, palpation of the affected area, and analysis of the patient’s complaints.
Laboratory research:
General blood analysis;
General urine analysis;
Bacteriological seeding of the infiltrate on the microflora;
Biochemistry of urine.
Instrumental research:
Ultrasound to assess the extent of inflammation;
CT, MRI (computer or magnetic resonance imaging) – is used in the diagnosis of extensive purulent tissue damage.
General treatment
When prescribing treatment, the doctor focuses on the causative agent of the infection, detected as a result of bacterial culture, separated from the wound, as well as on the severity of the patient’s condition. Usually, analgesics and antibacterial drugs are prescribed simultaneously. Limiting therapy to only conservative treatment does not always lead to the desired outcome. An abscess can provoke extensive necrosis, sepsis. For successful treatment, in many cases, an opening of a purulent focus and aseptic treatment of its cavity is required.
Treatment at the initial stage of infiltrate formation:
Cessation of injections into the affected area, emergency initiation of therapy;
The use of physiotherapy (gamma globulin electrophoresis, treatment with dynamic currents);
Introduction to the infiltrate area of proteolytic enzymes;
Dynamic monitoring of the development of the infiltrate – if fluid is found in it during ultrasound, with severe pain and swelling of the tissues, surgical treatment is prescribed.
Operative therapy
Self-treatment in the formation of a post-injection abscess is strictly prohibited, as well as expectant management. Purulent fusion of soft tissues is formed rapidly, necrosis is formed, the area of inflammation expands.
The most effective surgical treatment method is surgical necrectomy, or excision of non-viable tissues.
Intervention steps:
Formation of the primary seam.
enzymatic necrolysis.
Vacuum aspiration of pus with drainage.
Subsequent flow-flush drainage using sodium hypochlorite and proteolytic enzymes.
The last stage contributes to the prevention of secondary infection. Such a closed method of treatment contributes to the speedy healing of tissues affected by an abscess.
The previously used method of open treatment without the formation of a primary suture in 30% of cases led to infection of patients. The most common source of infection was Pseudomonas aeruginosa.
Buttock abscess puncture, which was previously common, is no longer relevant as a treatment method. Such manipulation provokes complications in the form of phlegmon, purulent streaks, the transition of the process into a chronic form.
Prevention
Post-injection abscess of the buttock leaves behind an unaesthetic scar with the formation of a hole in the skin and deformation of the adipose tissue.
Preventive measures to prevent complications that occur after injections:
Strict adherence to the dosage, compatibility of drugs, the rate of administration and the frequency of the drug;
Compliance with the rules for administering the drug – complete penetration of the needle into the tissues of the gluteal muscle;
Strict adherence to the rules of antiseptics, the use of sterile consumables, careful treatment of the injection site and the hands of the person who performs the injection;
Accurate determination of the topography of the injection, which is difficult to do in the treatment of obese patients with pronounced subcutaneous fat at the injection site;
Conducting a relaxing massage to improve the absorption of the drug;
The ban on the introduction of drugs in the same place.
After performing a surgical intervention, the patient is under the supervision of a doctor for 10-14 days. In the absence of somatic diseases, the prognosis for recovery is favorable. Rehabilitation consists in restoring the skin, the activity of the muscles of the limb, and increasing the patient’s working capacity.
It should be mentioned that more than 90% of all post-injection complications are based on bacterial origin. Staphylococcus aureus is considered the main causative agent of all kinds of suppuration. Pseudomonas aeruginosa is also often found. As a rule, after opening the focus of infection after 3 dressings, the amount of inoculation of Staphylococcus aureus decreases, and an increase in the inoculation of Pseudomonas aeruginosa indicates re-infection. In rather rare cases, bacteria of the genus Escherichia coli and Proteus can be found.
Previously, dangerous cases of clostridial anaerobic infection were recorded, which has not been observed recently. The strictest observance of certain rules for the technique of drug administration, injection technique and observance of asepsis provides full protection against the unpleasant occurrence of an abscess after an injection. All modern experts recommend, if possible, to limit the conduct of such procedures at home.