IV Therapy: Complication or Malpractice?

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Susan Masoorli RN is president and founder of Perivascular Nurse Consultants, a company that provides infusion training and direct patient care related to the insertion and maintenance of all types of vascular access devices. Susan is an expert witness in infusion related care, and has reviewed over 200 cases in the last 18 years. She has written extensively about IV therapy.

Susan answered these questions:

1. What is the difference between infiltration and extravasation?
2. Which medications are particularly caustic if they leak into the tissues?
3. Is an extravasation an accepted risk of IV therapy?
4. What is the proper method for assessing a peripheral IV device?
5. Is there a definition of frequent monitoring of the IV site?
6. How does the nursing shortage with the fewer numbers of registered nurses and the increased number of nursing assistants affect monitoring of IV sites?
7. What is the aftercare for infiltrations and extravasations?
8. Why should heat never be applied to an extravasation?
9. What kind of documentation is needed when an infiltration or extravasation occurs?
10. Why are neonates and the elderly at particularly high risk for extravasation?
11. Where would an expert witness, healthcare provider or attorney look for standards of care for IV therapy and vascular access devices?
12. What are the most critical clinical and legal issues related to infiltration and extravasation?
13. What negative outcomes are associated with infiltration and extravasation malpractice cases?
14. What kind of permanent damages do they cause?
15. What documents should be requested as a part of discovery for infiltration and extravasation malpractice cases?
16. Is an infiltration an indication that a departure from the standards of care occurred?
17. Is an extravasation an indication that a departure from the standards of care occurred?
18. What safety precautions should be used to protect a patient from a fall-related injury during or after a venipuncture?
19. Is nerve injury related to venipuncture a common area of malpractice?
20. Is there a typical symptom a person experiences when a nerve injury has occurred?
21. What does the person performing a venipuncture need to know to safely perform the procedure?
22. What two areas of the hand should always be avoided when an IV is started?
23. What is the primary risk of starting an IV in the inner elbow?
24. Why should the femoral area be avoided for IV access?
25. What is the primary risk of starting an IV in the jugular artery by mistake?
26. What is the first thing a person should do if there is a sign of a nerve injury during an attempt to insert a needle into a vein?
27. Is there any technology that permits visualization of the vein?
28. What information do you look for in the medical record to diagnose nerve injury?
29. Why are nerve injury cases often difficult for the plaintiff to win?
30. Are there any effective treatments for patients who have had nerve injuries?
31. A piece of IV catheter tubing can break off and travel to the heart. How does that happen?
32. What should a healthcare provider do when she or he realizes the plastic has disappeared?
33. Can you retrieve the plastic? What damages can it cause?

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You might also be interested in these resources:

From Susan Masoorli's chapter, "Intravenous Therapy Liability", in Nursing Malpractice, Third Edition, edited by Patricia Iyer and Barbara Levin

The question in many IV therapy malpractice cases is "Was the right catheter inserted into the patient?" The prescriber (physician, nurse practitioner, physician assistant) orders the IV medication or solution on the physician order sheet. In most cases, the type of access device is not ordered by the prescriber. The nurse reviews the IV orders and determines if a peripheral access device is appropriate based on the type of therapy, length of therapy, and the condition of the veins in the patient's arms. If the patient is not a candidate for a peripheral access device, the nurse notifies the prescriber and asks that a central vascular access device be inserted. It is the nurse's responsibility to safely infuse the medications/solutions through the appropriate intravenous device. There are many algorithms available on the Internet to assist in proper vascular access device selection for specific patients. There are several sources of standards of care for infusion therapy, but little evidence-based research to validate routine nursing procedures related to the care and monitoring of vascular access devices.

Read more of this chapter by our presenter, Susan Masoorli, in Nursing Malpractice.