DOI: https://doi.org/10.36347/sjmcr.2026.v14i11.017

Pages: 2475-2477

Accidental intra-arterial drug administration is a rare but potentially devastating iatrogenic event, particularly in infants in whom early symptoms may be difficult to recognize. We report a one-month-old male infant hospitalized for a multidrug-resistant respiratory infection and treated with amikacin and a third-generation cephalosporin. During placement of a peripheral vascular access in the right upper limb, the catheter was inadvertently positioned in the brachial artery and amikacin was administered intra-arterially. The arterial malposition was recognized approximately seven hours later, after the development of diffuse cyanosis of the hand and forearm, absence of spontaneous movement of the limb, and loss of brachial, radial, and ulnar pulses. The ischemia progressed rapidly to extensive necrosis of the hand and forearm. Because the limb was considered nonviable, a right transhumeral amputation was performed. The postoperative course was uncomplicated; treatment of the respiratory infection was completed over 14 days, and the amputation stump was completely healed at two-month follow-up. This case emphasizes the severe consequences of delayed recognition of accidental intra-arterial drug administration and the importance of careful verification and close monitoring of peripheral vascular access in infants.