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High Pressure Injection Injuries

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High Pressure Injection Injuries

Am I or My Employees at Risk? What You Need to Know.

[WARNING: This post contains graphic images that may be disturbing to viewers.]

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Image Below Taken from an SDS for:  Base Oil and Additives – Engine Oil

hazard identification
hazard identification

They are rare, perhaps you have not even heard of the term, “high-pressure injection injuries” until now…

This type of injury presents as a small puncture wound that is often underestimated by physicians and patients.

Why should you care?

If you or someone you know were injured in this manner, the injected substance could lead to extensive tissue damage and even the loss of the limb.  That’s serious and you need to care!

What causes the problem?

It does not have to be a toxic substance.  Injection injuries can occur from lubricants, solvents, paints, oils, grease, gasoline, even air, water & cement, and they can happen anywhere/anytime.

The aim of this article is to bring to your attention,  the severity of these apparently innocuous injuries and to raise awareness for safety and prompt diagnosis, along with effective treatment.

toxic substance figure 1
toxic substance figure 2
toxic substance figure 3

Avoid an Injury or Possible Amputation.

Please Take Safety Seriously.


AS per NCBI:

High pressure injection injuries result from the inappropriate operation of equipment that achieve ejection pressures of their contents sufficient to breach the human skin1.

These injuries are uncommon with an estimated incidence of one in 600 hand injuries presenting to an emergency care unit2. They occur predominantly in young men and are mostly occupational injuries3. The majority of the injuries affect the non-dominant index finger and occur usually due to inexperience in operating the high pressure equipment, inappropriate use, insufficient training, carelessness, fatigue at the end of the shift or rupture of the equipment35. The most commonly injected substances are paints, paint solvents, grease, fuel oil (paraffin oils, diesel oil, gasoline) but there has also been reported injection of water, air, cement, and animal vaccines6,7. In order to breach the human skin the ejection pressure has to be at least 100 pounds per square inch (psi)8 while most high-pressure guns and injectors reach pressures of 2000 to 12000 psi3.

The puncture wound is small, inconsiderable and not distinct. Initially the toxic substance causes edema and ischemia and later the combination of mechanical and chemical factors leads to compartment syndrome and consequently to fibrosis, adhesions, necrosis and secondary contractures and ulcerations, apart of the risk of systemic intoxication (acute renal failure, air embolism)1,9.


Hippokratia. 2008 Jan-Mar; 12(1): 33–36

1. Smith GD. High pressure injection injuries. Trauma. 2005;7:95–103. [Google Scholar]

2. Schoo MJ, Scott FA, Boswick JA. High-pressure injection injuries of the hand. J Trauma. 1980;20:229–238. [PubMed] [Google Scholar]

3. Hart RG, Smith GD, Haq A. Prevention of high-pressure injection injuries to the hand. Am J Emerg Med. 2006;24:73–76. [PubMed] [Google Scholar]

4. Jebson PJ, Sanderson M, Rao VK, Engber WD. High-pressure injection injuries of the hand. Wis Med J. 1993;92:13–16. [PubMed] [Google Scholar]

5. Valentino M, Rapisarda V, Fenga C. Hand injuries due to highpressure injection devices for painting in shipyards: circumstances, management, and outcome in twelve patients. Am J Ind Med. 2003;43:539–542. [PubMed] [Google Scholar]

6. Lewis HG, Clarke P, Kneasfey B, Brennen MD. A 10-year review of high-pressure injection injuries to the hand. J Hand Surg [Br] 1998;23:479–481. [PubMed] [Google Scholar]

7. Wong TC, Ip FK, Wu WC. High-pressure injection injuries of the hand in a Chinese population. J Hand Surg [Br] 2005;30:588–592. [PubMed] [Google Scholar]

8. Neal NC, Burke FD. High-pressure injection injuries. Injury. 1991;22:467–470. [PubMed] [Google Scholar]

9. Gutowski KA, Chu J, Choi M, Friedman DW. High-pressure injection injuries caused by dry cleaning solvents: case reports, review of the literature, and treatment guidelines. Plast Reconstr Surg. 2003;111:174–177. [PubMed] [Google Scholar]

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