Acute Caremiddle twist
A 58-year-old man is receiving intravenous vancomycin for a prosthetic joint infection through a 20 gauge cannula in the dorsum of the left hand. Six hours into the third dose the nurse reports that the infusion has slowed. The dorsum of the hand is swollen and cool to touch, the skin overlying the cannula tip is dusky with a 5 mm blister, and there is no blood return on aspiration. He is afebrile. There is no tender cord along the forearm veins, the forearm is soft and passive extension of the fingers is painless. Which one of the following has occurred?