Technique

Many of the patients seen by the Infectious Diseases team are IV drug users. As it turns out, injecting random substances into your veins is actually dangerous. Any bugs that you inject go via the venous system to the right side of the heart, where they can lodge and form vegetations on the heart valves. Once the vegetations become larger, they can affect blood flow, and also flick off to the lungs. From the lungs, apart from causing infections, they can wash to the left side of the heart, and from there … the rest of the body, even the brain.

We have patients with infective endocarditis (infections around the heart), infections in the brain, infections in the blood.

You’d think that Infectious Diseases doctors would be strongly against IV drug use, when patient after patient appears with serious infection, in need of IV antibiotics, with no veins available because they are all scarred and collapsed. What bothers the consultants the most?

“There’s no attempt at sterility at all”

Yes, the consultant is most annoyed about technique.

Last week we were called to see a lady with pus pouring out of her eye due to a bug commonly found in dirt. At first it looked like she’d injected with a dirty needle and the bacteria had entered the bloodstream. Later it emerged that, having ruined all of the veins she could find, including her jugular veins, this lady had injected into her eyeball. Straight in. Turns out the bacteria was just a contaminant on the swab, and most of the damage was done from the chemicals in the drug. I think the eye is being removed this week.

How’s that for technique?