Injecting drug use via femoral vein puncture: preliminary findings of a point-of-care ultrasound service for opioid-dependent groin injectors in treatment

Abstract

BackgroundWithin the UK, injecting in the femoral vein (FV), often called 'groin injecting', is a serious cause of risk and harm. This study aimed to use ultrasound scanning as a means to engage groin injectors (GIs), examine their femoral injecting sites and assess their venous health, with the intention of developing improved responses.MethodsBetween September 2006 and March 2009, GIs attending a network of community drug treatment centres in South East England were invited to attend an ultrasound 'health-check' clinic. This paper provides a narrative account of the scanning procedure and operation of the service, with descriptive statistical analysis of GIs who attended. The analysis uses a structured, specially-developed clinical data set that incorporates a categorisation for the severity of FV damage. Case studies using ultrasound images and a link to a video are provided to illustrate the range of presentations encountered and the categorisations used for severity.ResultsA total of 160 groin scans (76 bilateral and 8 unilateral) were performed in 84 GIs. The majority were men (69.0%) and the mean age of the sample was 36.8 years. The mean duration of drug use and injecting drug use was 19.7 years and 13.8 years, respectively. FV damage at the injecting site in the right groin was graded as minimal in 20 patients (25%), moderate in 27 (33.8%), severe in 16 (20.0%) and very-severe in 17 (21.3%). Corresponding figures for left FV were 24 (30.0%), 22 (27.5%), 18 (22.5%) and 16 (20.0%). Wide variation was observed in the time to the development of these grades of FV damage.ConclusionsModern, portable ultrasound scanners make it possible to examine the venous health of GIs in community treatment settings. Ultrasound scanning identified extensive FV damage, much hitherto-unrecognised in this population. These findings should further alert clinicians, policy-makers and patients to the urgent need for effective harm reduction responses to GI behaviour. Images of damaged FV in this paper might prove to be a useful resource for discussions about GI risks.

Right Inguinal Varicose Vein in Connection with Femoral Vein Following Intravenous Drug Abuse: A Rare Radiologic Finding

“…Unusual etiologies of varicose veins in the lower extremities was evaluated in study conducted by Seung Chai Jung et al [8]. They reported that the major rare factor of developing varicose vein was vulvoperineal varicosity, fol- that heroin was the most common drug with was abused and deep vein thrombosis was the most prevalent complication [9]. The diagnosis of the disease is not so difficult but the etiologic factor is important and always is questionable.…”

Evaluation of Femoral Ultrasonography as a Tool for Promoting Cessation of Groin-Injecting Behaviour

“…The date UFV was performed on each case was set as the ‘baseline' date for the corresponding control. Previous reports have presented data on early fractions of GIs in the UFV group [11,17,20]. …”

“…The ultrasound equipment, operation of the service and the scanning procedure were as previously described [20]. In summary, patients who received UFV were screened for presence of venous or arterial damage and changes in blood flow at the groin-injecting site(s) using real-time and single-frame images, colour blood flow and spectral tracings generated by MicroMaxx™, a portable ultrasound scanner.…”

“…Ultrasonography, a first-line diagnostic tool in many medical specialties [19], has only recently started to receive research attention within the addictions field. Ultrasound characteristics of a wide range of groin-injecting complications [9] and the use of ultrasonography for investigation of FV damage among GIs [11] and for bolstering health-affirming messages within drug clinics [20] have been described. …”

Associations between injecting illicit drugs into the femoral vein and deep vein thrombosis: A case control study

“…Furthermore, the groin was reported to be more convenient and provided quick access and less pain than smaller veins elsewhere on the body . Yet the practice of injecting in the groin is dangerous, and risks include not only missing the vein but also hitting the nearby femoral artery resulting in haemorrhage or possible severe arterial damage . Despite these risks, groin injecting may be considered an ‘acceptable risk’, which PWID are willing to take .…”