Four tips to help prevent botched IV attempts and IV infections
Avoid serious IV complications by paying attention to these important factors
I just finished representing the family of a newborn girl who was injured shortly after birth. I’ll call this beautiful little girl Elsie. I was at a hearing today at the Harris County Civil Courthouse in Elsie’s case and had the opportunity to think back to what happened.
What injured Elsie should have never happened. The nurse placed an IV in the back of her hand did not get a vein. Instead, the needle was pushing the medication into the surrounding tissue and caused big problems. This type of medical nursing error not only happens in newborns. A nurse can make the same mistake on a child, teenager, adult, or senior.
Before we get any more into this, I should first finish telling Elsie’s story.
IV injuries in newborns and children
Elsie’s mother went into pre-term labor when she was 36 weeks into her pregnancy. The mom and dad rushed to a Clear Lake area hospital in suburban Houston, and got her admitted to the labor and delivery unit. It was not long until Elsie was born.
The doctors quickly recognized that Elsie was not as active as they would like to see. She also was having some problems breathing, which they described as moderate respiratory distress. In checking little Elsie out further, the doctors felt that she had neonatal clinical sepsis, which is an infection that spreads in the blood stream.
Sepsis was probably the culprit in causing Elsie’s breathing problem, so the doctors decided to give her antibiotics and transfer her to Galveston’s University of Texas Medical Branch (UTMB) John Sealy Hospital.
While they were waiting for Elsie to get transferred to UTMB, she was in the neonatal intensive care unit (NICU) and her parents could only see her from an observation window.
A doctor wrote an order for two antibiotics that Elsie’s nurse was to give her through an intravenous (IV) line in the back of her hand. That was the plan.
The nurse missed the vein and a powerful antibiotic started flowing and running into the wrong place. Elsie was covered up, so her parents could not tell. And the nurse did not bother to check the IV for three hours and 55 minutes. When she finally did, she discovered that the back of Elsie’s hand had blown up like a balloon with all of that medicine going into the wrong place. It is called IV infiltration or extravasation.
Fortunately, Elsie eventually recovered, but was left with a nasty scar that covers most of the back of her right hand. She will need plastic surgery.
IV injuries in adults
A few years ago, I represented another client who had been a patient at Cypress Fairbanks Medical Center for a gastric bypass. She was admitted to the hospital two more times because of ongoing pain in her stomach, difficulty eating, nausea, and vomiting.
On one of the admissions, a doctor ordered total parenteral nutrition (TPN), which is a way of getting patients extra calories through an IV line. It is used when people are having a problem holding down food and liquids.
A nurse followed the order by attempting to place a PICC line and then a midline catheter. When it came time to change the catheter, a nurse removed it and noted redness, pain, and puss at the site. The nurse also noted what she described “a small amount of light brownish” substance where the catheter went into the skin.
We hired a nursing expert and a board certified lap band surgeon to review the medical records in that case. The nursing expert concluded that the nurses did not meet the standard of care because they never told the doctor about this problem or sent the catheter in for a culture to see if it was infected. The bariatric surgeon explained that the pain, redness, swelling, and pus were all signs of an infection that were ignored and turned to sepsis.
Four tips to help prevent botched IV attempts and IV infections
Elsie's parents were not able to speak about and stop the nurse's IV mistake because their newborn was in the NICU. But in many situations, these three tips can really help.
(1) Make sure that they clean and sterilize the area that they are about to stick with the needle. If they forget, speak up.
(2) Tell the doctor or nurse if there is immediate pain or burning when the IV starts flowing.
(3) After the IV starts flowing, make sure you do not see any swelling or discoloration. In other words, make sure that the medicine is going into a vein. If your skin starts to bubble up, there is likely a problem and you could notify your nurse immediately.
(4) If the IV is in place for a while, keep an eye out for redness, swelling, and pain. Point this out to your doctor and nurse in a way that they do not just dismiss is as normal.
When there is an IV infection, you want to make sure that it is diagnosed and treated as soon as possible. The IV itself is a foreign object that is a great place for bacteria to grow and thrive. When the line is pulled out, the bacteria can scatter straight into the bloodstream and cause sepsis.
We are here to help
Have you or someone you care for had an injury caused by an IV that was not inserted properly? Or perhaps by sepsis caused by an infected IV or catheter? Call 281-580-8800 for a free consultation with the Houston medical malpractice infection and sepsis lawyers at Painter Law Firm.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements [...]read more
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes [...]read more
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine
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