A high pressure injection injury is an injury caused by high-pressure injection of oil, grease,

diesel fuel Diesel fuel, also called diesel oil, heavy oil (historically) or simply diesel, is any liquid fuel specifically designed for use in a diesel engine, a type of internal combustion engine in which fuel ignition takes place without a spark as a re ...

gasoline Gasoline ( North American English) or petrol ( Commonwealth English) is a petrochemical product characterized as a transparent, yellowish, and flammable liquid normally used as a fuel for spark-ignited internal combustion engines. When for ...

, solvents, water, liquified plastic or even air, into the body. The most common causes are accidents with grease guns, paint sprayers, and

pressure washer Pressure washing or power washing is the use of high-pressure water spray to remove loose paint, mold, grime, dust, mud, and dirt from surfaces and objects such as buildings, vehicles and concrete surfaces. The volume of a mechanical pressure w ...

s, but working on diesel and gasoline engine fuel injection systems as well as pinhole leaks in pressurized hydraulic lines can also cause this injury. Additionally, there is at least one known case of deliberate self-injection with a grease gun. Although the initial wound often seems minor, the unseen, internal damage can be severe. With

hydraulic fluid A hydraulic fluid or hydraulic liquid is the medium by which power is transferred in hydraulic machinery. Common hydraulic fluids are based on mineral oil or water. Examples of equipment that might use hydraulic fluids are excavators and backho ...

s, paint, and detergents, these injuries are extremely serious as most hydraulic fluids and

organic solvents A solvent (from the Latin language, Latin ''wikt:solvo#Latin, solvō'', "loosen, untie, solve") is a substance that dissolves a solute, resulting in a Solution (chemistry), solution. A solvent is usually a liquid but can also be a solid, a gas ...

are highly toxic. Delay in surgical treatment often leads to amputations or death. But even with pure water or air, these injuries cause

compartment syndrome Compartment syndrome is a serious medical condition in which increased pressure within a Fascial compartment, body compartment compromises blood flow and tissue function, potentially leading to permanent damage if not promptly treated. There are ...

, which leads to cell death if surgical intervention is delayed.

Signs and symptoms

Small punctate lesions may be the only skin lesions visible at first, and there may not be any discomfort. Such a benign presentation of painless wounds may cause the patient to postpone getting medical attention. But as the swelling increases, loss of perfusion causes pain and

paresthesia Paresthesia is a sensation of the skin that may feel like numbness (''hypoesthesia''), tingling, pricking, chilling, or burning. It can be temporary or Chronic condition, chronic and has many possible underlying causes. Paresthesia is usually p ...

, and the finger becomes bloated, pale, edematous, tense, and cold.

Causes

Most injuries are caused by inexperience using high-pressure equipment, improper use, inadequate training, negligence, exhaustion at the end of the shift, or equipment rupture. Paints, paint solvents, grease, and fuel oils (diesel, paraffin, and gasoline) are the substances that are injected the most frequently, but reports of injecting water, air, cement, and animal

vaccines A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease. The safety and effectiveness of vaccines has been widely studied and verified. A vaccine typically contains an ag ...

have also been made. The majority of high-pressure guns and injectors reach pressures of 2000 to 12000 pounds per square inch (psi), but the ejection pressure must be at least 100 psi to penetrate human skin.

Treatment

Analgesia Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals ...

, systemic prophylactic

antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...

, elevation of the affected limb, and

tetanus Tetanus (), also known as lockjaw, is a bacterial infection caused by ''Clostridium tetani'' and characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usually l ...

prophylaxis if necessary are all part of the initial management. Avoiding digital blocks is advised because they could exacerbate

vasospasm Vasospasm refers to a condition in which an arterial spasm leads to vasoconstriction. This can lead to tissue ischemia (insufficient blood flow) and tissue death (necrosis). Along with physical resistance, vasospasm is a main cause of ischemi ...

and swelling in a digit that is already at risk. In the emergency department, wounds should be left open without any attempt at primary closure. Ice is also discouraged because the goal is to maximize the hand's perfusion after injection. Only injections of chicken vaccine, air, or water qualify for nonsurgical treatment; expectant management of these injuries is an option. Surgical decompression is only necessary for high-pressure water injuries in cases where compartment syndrome symptoms are present.

Epidemiology

With an estimated frequency of one in 600 injuries presenting to a hospital, these injuries are rare. These injuries mostly affect young men and are related to the workplace.

References

External links

StatPearls
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