Injectioninjurytraining

Fluid Injection Injury Prevention Training

Contains public sector information licensed under the Open

Government License v3.0.

Chris Russell

U.S. Army Corps of Engineers

February, 2015

What You Will Learn

• The fundamentals of fluid injection injuries

• Sources of potential injuries

• How to identify fluid injection injuries

• Importance of immediate medical care

• Methods of protection/avoidance

• Sources of additional information

What is a fluid injection injury?

Injection injuries can be defined as the

puncturing of the epidermis by a jet of a fluid

under pressure. Hydraulic injection injury is the

term used to describe an injury sustained by an

individual following an injection of fluid,

usually while operating or inspecting

pressurized hydraulic equipment.

Basics of fluid injection injuries

Pressurized fluids such as those found in

hydraulic applications can travel at the speed of

a bullet and penetrate all known levels of

personal protective equipment.

Skin penetration can occur at pressures as low as

100psi and from 4 inches to the source.

Sources of fluid injection injuries

• Paint spray guns

• High pressure lube guns

• Hydraulic lines or fittings

• Pressure washers

• Fuel injection systems

Why this is important to know?

Hydraulic injection injuries are usually occupational

and sustained by workers, both skilled and

unskilled, with injuries mostly sustained to the

palm or pads of the digits of the hand. Most often a

lack of comprehension of the potential severity of

injuries of this type on the part of the injured party

and medical professionals is the main obstacle to

effective treatment. This appears to be largely due

to the apparent benign initial presentation of the

wound. If untreated, hydraulic injection injuries

can, and have, result(ed) in amputation or even

death.

Components required for injury

Pressure – Force of the fluid jet measured in Newtons

Proximity – How close your body part is to the jet

Jet size – Diameter of orifice where fluid is expelled

It is obvious that if one of these variables is absent or

diminished the chances of sustaining injury through

hydraulic injection are significantly reduced.

Severity factors for injury

Type of fluid

Amount of fluid

Pressure of fluid stream (depth of injection)

Toxin or bacteria in fluid

Degree of spread (directly affected by time)

Delay of treatment

Typical initial injury to the hand

The left hand of a 33 year old

industrial paint sprayer shortly after

sustaining an injection injury of oil

based paint to the base of the index

finger. Note the seemingly benign

nature of the puncture wound where

the paint has entered the hand.

picture by R Heirner

Typical initial injury to the hand

One of several incisions made during

the debridement process to remove

necrotic tissue and paint.

picture by R Heirner

Typical initial injury to the hand

The right hand of 25 year old male 36

hours after sustaining a hydraulic

injection of solvent into the pad of the

index finger. Due to the initial innocuous

presentation of a small puncture wound

on the finger, medical advice was not

sought upon sustaining the injury.

Necrosis of the tissue can already been

seen at the tip of the finger.

picture by ZH Dailiana

Typical initial injury to the hand

The patient after undergoing a

wide surgical debridement

and pressure relieving of the

compartments of the hand.

This procedure took place 56

hours after the initial injury.

picture by ZH Dailiana

Typical initial injury to the hand

After amputation of the index finger.

picture by ZH Dailiana

Typical initial injury to the hand

Another common injury site

is the palm of the hand,

commonly sustained when

using a piece of hydraulically

powered equipment at the

point at which a material or

component failure occurs.

picture by ZH Dailiana

Fuel oil injection to the palm

Typical initial injury to the hand

The same patient undergoing

surgical debridement in order to

relieve the pressure from the

inner compartments of the hand

and remove necrotic tissue.picture by ZH Dailiana

Preparing for an injury

• Contact your local medical facility and ask them if they

are familiar with fluid injection injuries

• Determine the closest facility with the means to deal

with these emergencies

• Develop an EAP (Emergency Action Plan) and rehearse

• Educate all your team members on potential hazards of

fluid injection injuries, prevention and treatment

• Institute risk mitigation measures for injection injuries

What to do?

• Get a copy of the MSDS (Material Safety Data Sheet)

• Immediately transport the individual to a MTF (Medical

Treatment Facility)

• Notify hospital staff that you suspect a fluid injection

injury and give them the MSDS

• Lock-out, tag-out and deenergize suspected equipment

What not to do?

• Apply a tourniquet

• Underestimate the injury

• Attempt to clean the wound

• Allow the injured to eat or drink anything

Ways to prevent injuries

• Maintain 12” distance (stand-off) from sources

• Use a barrier to check for leaks (wood, cardboard, etc.)

• Ensure all hoses are protected from chafing

• Inspect components on routine basis

• Replace (never repair) worn hoses or components

• Wear all recommended PPE when working with, on,

or around hydraulic systems or components

Resources

• www.fluidpowersafety.com

• http://www.hse.gov.uk/safetybulleti

ns/hydraulic-injection-injury.htm

• http://www.ncbi.nlm.nih.gov/pmc/ar

ticles/PMC2532970/

• http://www.wikem.org/wiki/High-

Pressure_Injection_Injury

Where can I find

more information?

Remember

• The bottom line when dealing with any

suspected fluid injection injury is speedy

treatment.

• When in doubt, get a second, or even a third

opinion. Few people care as much about you

as you do.

• These injuries can be fatal and, even in the

best cases, are career ending, life altering

events that are completely preventable.

What You Have Learned

• The fundamentals of fluid injection injuries

• Sources of potential injuries

• How to identify fluid injection injuries

• Importance of immediate medical care

• Methods of protection/avoidance

• Sources of additional information

What are your questions?

This slide show is available for download from the

Hydropower Apprentice Program Sharepoint portal

located at

https://team.usace.army.mil/sites/NWW/Train/Hydro

Power%20Apprentice%20Program/Forms/AllItems.a

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If you have any questions, comments or suggestions please email

[email protected]