Needle embolism is an infrequent complication of intravenous drug users (IDUs) [1]. Broken needles occur most commonly when the needle separates and comes apart from the hub. Inflammation and infection after needle embolism are relatively common in local wound site. While the central embolim of needle fragmentscan potentially cause serious complications such as cardiac perforation, pericarditis, infective endocarditis, arrhythmias, and pulmonary abscess [1]. In most cases, it is recommended to remove the needle once the embolism is found in order to prevent delayed complications [2].
Illicit drug use is an intractable and global public health problem. According to the World Drug Report 2016 [3], 250 million of people between the ages of 15 and 64 years used drugs in 2014. Over 29 million people who used drugs suffer from drug use disorders, of whom 1 in 6 is in treatment. What’s worse, the most current data available showed that 12 million people had a history of injecting drugs globally [4].Compared with the traditional way of taking drugs, IDUs are exposed to more health-related harms and have a high risk of premature death. Poor health conditions, unsterilized injecting sites and drug dissolving agents are the leading causes of bacterial infection. Because of poverty or convenience, sharing and repetitive use of needles is a common phenomenon which is the main cause of Human Immunodeficiency Virus (HIV) and HCV infection. About half of IDUs are estimated to share needles worldwide [5]. A recent surveillance surveys among IDUs in China also showed that 47.7% reported ever sharing needles [6]. The statistics from World Drug Report 2016 shows that 14% of IDUs are living with HIV and 50% with hepatitis C in 2014 [3].Several studies have shown that IDUs have a disproportionate prevalence (60-80%) of HCV infection globally [7,8,9]. The most current data available in China also showed that in 2011, 67% of IDUs are living with HCV [8]. In addition, studies have reported that people often have risky sexual behaviors after injecting opiates, resulting in the risk of HIV infection [7,8,9].
Bạn đang xem: Case report: surgical removal of a migrated needle in right ventricle of an intravenous drug user
A cross-sectional survey study in United Kingdom published in 2002 found that 20% of IDUs had experienced a broken needle during the course of their injecting careers [10]. Given the great number of IDUs in China, subsequent needle embolization may be more common than it appears, particularly as drug misusers tend to avoid hospital unless seriously ill. Broken needles are hidden risks for IDUs and central needle embolism could even result in severe complications in heart and lung. Hence it is necessary to increase the familiarity with needle embolism, as an unusual but life-threating complication of IDUs.
In Mainland China and other districts in Asia, compulsory drug rehabilitation is a primary strategy for drug users. However, harm reduction approaches such as methadone maintenance treatment (MMT) and needle-syringe exchange projects (NSPs) are widely promoted in recent years. In Mainland China, a total of 767 methadone maintenance treatment clinics had been set up in 28 provinces by the end of 2014 [11].While in Changsha, the city where our hospital located, 1990 patients received treatment in a total of 3 MMT clinics in 2013 [12]. Meanwhile, needle-syringe exchange projects were pushed forward in Mainland China. In 2014, NSPs were held in 14 provinces, with 814 needle exchange sites. Over 56,000 drug users participated in the projects and more than 11 million needles and syringes were handed out [11].
It was necessary for this patient to have drug rehabilitation treatment after being discharged. We recommended him to attend MMT and NSP. According to several studies in China, MMT can significantly reduce criminal activity and improve employment rate and social well-being, that helps drug users to resume societal and familial functions [6, 13, 14]. And NSPs decreased levels of injecting frequency, repetitive use and sharing of injecting equipment among Chinese IDUs.
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