Nurses are generally responsible for placing intravenous (IV) catheters and infusing drugs and fluids through IV lines. While IV lines are a routine part of daily medical care, they have well-documented risks including infection, over-dosing medications, and nerve injury. Another important danger is extravasation injury which occurs when fluid or medication leaks from the IV site into surrounding tissue. Fluid extravasation often leads to tissue injury when the fluid pressure compresses skin, muscles, blood vessels, and nerves. Medication extravasation may cause pressure effects as well, though the main threat is when the extravasated drug (extravasant) causes toxic harm to local tissue. This is particularly common with chemotherapy drugs, though hundreds of other medications – including common drugs like Phenergan – are known to cause limb-threatening injuries when they extravasate. Whether extravasation injuries occur from direct pressure or local toxicity, patients are at risk of devastating harm ranging from tissue death (necrosis) to amputation. When this occurs, there is a high risk of litigation against nurses and hospitals.
Extravasation is relatively uncommon with one study estimating injury in 0.1% to 6% of patients receiving chemotherapy. However, this is likely underestimated because of under-reporting. Injuries are most likely to involve the dorsum of the hand and foot, ankle, antecubital fossa, and near joints or joint spaces where there is little soft tissue protection for underlying structures. Small children, as well as patients with cancer, diabetes, and other underlying illnesses are at particular risk of complications. Because extravasation is such a well-documented complication of intravenous lines, the goal is to take appropriate precautions to prevent it from occurring in the first place. According to the Regional Director of Nursing at AccessRN, “[t]he current standard is to use imaging techniques to prevent patient injury as much as possible,” but nurses may not always be educated on methods such as ultrasound-guided peripheral infusion.
Extravasation may also complicate well-placed lines when the catheter tip migrates out of the vein or the vein ruptures. Because of the risks of injury, hospitals typically have extravasation protocols which set forth the standards and procedures for nurses to follow. Extravasation protocols may be limb-saving when there is a specific antidote or rescue technique that must be urgently administered. It is for this reason that litigation often focuses on the failure to recognize extravasation in a timely manner and/or the failure to follow an appropriate extravasation protocol. As a result, when a claim arises, counsel on both sides should review the hospital’s protocol and the healthcare team’s compliance with every element of intravenous line management from placement, to monitoring, to management of complications.
For complications involving IV lines during routine patient care, a Nursing Expert Witness (e.g., Medical-Surgical Floor Nurse, ER Nurse, or ICU Nurse) will be able to handle most issues. For IV complications during chemotherapy, an Infusion Nurse certified in chemotherapy is the requisite expert. Such nurses can offer testimony regarding the standard of care for IV placement, patient monitoring, recognition of complications, and compliance with extravasation protocols. A Hospital Administration Expert Witness can testify as to whether the hospital’s extravasation protocols and training, supervision, and oversight of nurses were appropriate. Expert witnesses in Plastic Surgery and Hand & Upper Extremity Surgery may be called to shed light on causation and prognosis.
If you are handling an intravenous extravasation claim, please contact Elite Medical Experts. We can help you find nationally recognized experts for your case.