Needle Hematoma

Glaser, J., Mann, O., Siegmuller, M., Rausch, J. Prospective study of the incidence of ultrasound-detected hepatic hematomas due to percutaneous Menghini needle liver biopsy and laparoscopy-guided Silverman needle biopsy. Ital. X Gastroenterol. 1994 26 338-341... 

In 55 patients, continuous lumbar sympathetic blockade with local anesthetics administered via a catheter to treat sympathetic pain caused a psoas abscess in two patients, both of whom were treated with a continuous infusion of 0.25% bupivacaine (28). It was assumed that the catheter had been dislodged and that the drug had been injected into the psoas muscle or the psoas sheath. Another reason for this complication could have been local trauma due to a hematoma around the vertebrae during the insertion of the needle. The main drawbacks of the technique were the high incidences of infections and displacement of the catheters. 

In a prospective UK survey of members of the medical and physiotherapy acupuncture organizations in Britain the preliminary data included 25 500 treatments given by 77 acupuncturists (64). There were 29 major events, including four episodes of loss of consciousness and one tonic-clonic seizure. The most common minor events were bleeding or hematoma (3%), aggravation of symptoms (1%), and pain during needling (0.9%). 

A 48-year-old obese woman had a 22G interscalene catheter inserted under local anesthesia via a short-bevel stimulating needle. Anesthesia was achieved using 0.6% ropivacaine 40 ml followed by an infusion of ropivacaine 0.2% for effective analgesia. On day 3, she reported blurred vision and a painful neck swelling. She had developed a hematoma around the catheter insertion site (confirmed by ultrasound) and had an ipsilateral Homer s syndrome including myosis, ptosis, enophthalmos, ipsUateral anhidrosis, and conjunctival hyperemia. 

Permanent or temporary deficits of spinal cord function are caused either by cord ischemia after arterial hypotension, or by cord compression due to an epidural or subdural hematoma or infection, or injury to the spinal cord and nerve roots as a consequence of needle puncture, introduction of a catheter, or chemical irritation. 

Postural headache is a common comphcation of spinal anesthesia (so-called postdural puncture headache). It is caused by CSF leakage through the puncture site. The incidence has been greatly reduced by the use of smaller-gauge and pencil-point spinal needles. However, headache (or psychosis) can be the presenting sign of subdural hematoma, which has twice been observed in women given spinal anesthesia for childbirth (SEDA-18,143). 

Observational studies A survey of 13 Oriental medicine doctors in Korea identified 99 adverse events (3.2%) among 3071 acupuncture treatment sessions in 2226 patients. Common adverse events included hemorrhage (32%), hematoma (28%), and needle site pain (13%) [84 ]. 

The BH is not just a variation on the RL, but is an entirely different way of performing cannulation and requires different attitudes and skills of the dialysis nurse. Several studies have compared the cannulation of the BH versus the RL technique and showed potential benefits of the BH with reduced risk of access-related complications such as needle infiltration and subsequent hematoma formation, aneurysm formation, and cosmetic appearance, cannulation ease and less pain. 

There are three main complications of muscle tear cysts and myositis ossificans and, more rarely, calcific myonecrosis (Peetrons 2002). Intermuscular and intramuscular cysts may be encountered after muscle trauma as well-defined echo-free masses with posterior acoustic enhancement. These cysts have an elongated shape and represent the residue of a local hematoma. Their most common location is the calf (see Chapter 15). In selected cases, they may require percutaneous needle evacuation. Calcific myonecrosis is a space-occupying calcified mass that typically develops in the anterior compartment of the leg late after a closed lower extremity... 

Fig. 13.27). In some cases, bundles of disrupted muscle fibers can be seen projecting inside the hematoma. US is helpful in evaluating these patients because deep collections caimot be distinguished from a swollen muscle based on physical examination alone. US detection of the hematoma can influence the treatment, establishing the indication for needle evacuation. 

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