Tennessee inmate Christa Pike survived an attempted lethal injection Wednesday night that involved multiple difficulties establishing intravenous (IV) access, raising questions about the execution procedure and the administration of the drug pentobarbital.

According to Pike’s attorneys, the execution team used at least seven needles in efforts to find suitable veins for the lethal drug delivery. Despite these attempts, Pike survived the procedure but was left with blistering and burning around the IV sites. Her lawyers reported that she remains in critical condition and is receiving intensive medical care.

Medical experts consulted by Pike’s legal team suggested that the pentobarbital likely leaked into the tissue surrounding the veins rather than entering the bloodstream, a condition known as IV infiltration. This would have prevented the drug from reaching the necessary concentration in Pike’s circulatory system to induce death. However, exposure of surrounding tissues to the drug may have resulted in chemical burns and could have caused permanent brain damage by reducing oxygen levels or impairing circulation.

The Tennessee Department of Correction (TDOC) stated that the execution followed the state’s established protocol approved by the attorney general’s office but declined to comment on what caused the complications during the procedure.

Pike’s history of medical issues may have contributed to the difficulties. Her lawyers said she has a blood disorder that complicates finding veins, and doctors have historically struggled with blood draws. During the execution attempt, Pike reportedly tried to assist prison staff by suggesting alternate sites for IV insertion.

Observers of the execution noted Pike’s expression of pain, including a moment when she reportedly described a burning sensation near the injection sites and questioned whether it was normal. Experts said such pain is a warning sign of IV infiltration. Dr. Mark Heath, assistant professor of anesthesiology, said the pain should have signaled an issue with the IV lines, which may have allowed pentobarbital to leak into the tissue.

Dr. Joel Zivot, an anesthesiology professor who has served as a medical expert for Pike’s defense, noted that pentobarbital’s chemical properties can cause severe tissue damage if improperly administered. He also indicated that Pike’s small and fragile veins likely increased the risk of infiltration, which can result in chemical burns resembling bleach damage.

Pentobarbital, a barbiturate mainly used to induce coma and suppress nervous system activity, is a common drug for lethal injections and euthanasia. It shuts down brain activity, including the respiratory centers, leading to respiratory failure and cardiac arrest. The drug’s use in executions has been scrutinized due to the difficulty in obtaining pharmaceutical-grade pentobarbital. Manufacturers often restrict its sale for use in capital punishment, prompting states to rely on compounding pharmacies or other less regulated sources, which raises concerns about the drug’s quality and effectiveness.

The use of pentobarbital for executions was adopted by the federal government during the first Trump administration but was rescinded in early 2025 under the Biden administration amid concerns over possible undue pain and suffering. The current administration has since reinstated it, alongside alternative methods such as firing squads.

Pike’s attorneys expressed concern that warnings about her medical conditions were not heeded before the execution attempt and called for preservation of all records related to the procedure in order to understand how it failed. They also highlighted the apparent damage to one needle used during attempts to establish intravenous access.

Historically, lethal injections in the United States have faced criticism due to instances of botched executions, often attributed to challenges in obtaining drugs, lack of medical expertise during administration, and the absence of transparency in protocols. Critics argue that lethal injection procedures may mask but do not eliminate the potential for pain and suffering.

Medical experts underscore that surviving a nonfatal dose of pentobarbital still poses risks of profound medical complications, including potential long-term brain injury. Pike’s case adds to ongoing debates about the safety, efficacy, and ethics of lethal injection executions.