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Cardio Exam

Injection Sites

July 1st, 2020


Track marks are a sign of IV drug use; in the context of the cardiovascular exam this is a significant risk factor for infective endocarditis, however IV drug use can also be a risk factor for other infections as well as vascular damage.
  • Look For

  • Injection sites along the course of peripheral veins. Note whether they are actively inflamed or scarred.
Track marks are most common at the bilateral antecubital fossae, though drug abusers tend to migrate to other sites once venous access has become difficult in this area due to inflammation and scarring.
  • Diseases Associated with IV Drug Use

  • Blood-borne viral infection - hepatitis C, hepatitis B, HIV
  • Bacterial septicaemia
  • Infective endocarditis - especially right-sided (tricuspid) disease
  • Cutaneous infection - skin abscess, cellulitis, necrotizing fasciitis
  • Venous damage - thrombophlebitis, deep venous thrombosis
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