IV therapy is often an essential component of medical treatment, yet carries risks that can be life threatening. An air embolism is a medical condition caused by oxygen bubbles in the bloodstream. Death may occur if a large amount of air becomes lodged in the heart, stopping blood flow. The Center for Medicare and Medicaid Services has identified air embolism as one of the preventable “never events” for which reimbursement will be denied. Learn why this condition is such a swift killer, and what should be done to prevent unnecessary deaths. The second never event and killer is an IV catheter-related infection, which causes a high death rate. The presenter discusses the risks, consequences, and preventive aspects of sepsis. She focuses on the liability aspects of both of these conditions.
The presenter is an intravenous therapy expert witness who educates nurses how to avoid air embolism through both peripheral and central venous access devices. The content will assist attorneys and legal nurse consultants who are involved in litigation after an air embolism or IV catheter infection occurs, as well as healthcare clinicians interested in knowing how to prevent patient deaths from these conditions.
Susan Masoorli RN is a Philadelphia-based 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.
Sue Masoorli answered these questions:
- How long have air embolism issues been of concern?
- What are air emboli?
- Can they be detected by diagnostic testing?
- What are some key ways in which air can get into the system?
- How do those mechanisms relate to the standard of care?
- Why do manufacturers offer Luer slip devices if these are more dangerous?
- How do holes get into IV tubing?
- What precautions should be followed when a central catheter is removed from the vein?
- What is an occlusive dressing?
- What should the patient be instructed to do during central catheter removal?
- What emergency equipment should be at the bedside when a patient has a central catheter in place?
- What are nurses expected to do if a confused patient is trying to pull out lines?
- What are the symptoms of an air embolism?
- How quickly can a patient die of an air embolism?
- Is there any way to get the air out?
- In the cases that you’ve been involved in as an expert, what has been the outcome for the patients who have gotten air in their system?
- What types of catheters are considered high risk for air emboli?
- What factors have to be present for an air embolism to occur?
- What are the key legal issues that seem to come up in establishing the negligence or the defense aspects of a particular air embolism case?
- Are air embolism cases difficult for the plaintiff to win?
- How common and costly are air embolism cases?
- What is the impact on the patient of getting sepsis from an IV catheter?
- Is it difficult to establish liability with a catheter related infection?
- What key step in IV catheter insertion is not commonly employed?
- What does “stop the line” mean?
- How costly are IV catheter related infections?
- Are there ways to increase compliance with hand washing?
- What is an easier aspect of liability to prove related to IV catheter sepsis?
- What are some classic symptoms that would be seen in somebody who is developing sepsis from an IV catheter?
- Which two groups of patients are at high risk for problems caused by removal of PICC lines?
- Which two central catheter insertion sites have the highest risk of infection?
- What are your recommendations for avoiding IV catheter-related sepsis?
- From the liability perspective, if an attorney has a case involving an IV catheter line, what suggestions would you provide to the attorney who is trying to determine if there is indeed liability associated with that catheter-related sepsis?
Extracted from Sue Masoorli, “Intravenous Therapy Malpractice” in Patricia Iyer, Barbara Levin, Kathleen Ashton and Victoria Powell (Editors), Nursing Malpractice, Fourth Edition, Lawyers and Judges Publishing Company
Attorneys and other legal professionals are called upon to review medical records of patients who sustain musculoskeletal injuries for several reasons. When injuries result from a motor vehicle collision, assault or workplace accident that generates a tort claim, attorneys need to cull several key pieces of information from the medical record including the cause of the patient’s injuries, the breadth and seriousness of the injuries, the extent of medical or surgical treatment necessary to address the injuries, and the resultant long-term disability associated with the injuries. In other cases, attorneys representing insurance companies or employers review medical records to ascertain whether patients are receiving the appropriate level of disability benefits. Finally, when there is a question of medical malpractice, plaintiffs’ and defendants’ attorneys review the written medical record to determine whether the appropriate standard of care was met. Attorneys reviewing the record in the context of tort injury or disability claims should focus on this evidence as it is germane to causation. The mechanism of injury may be documented in multiple places in the written record including the on-scene report of the emergency medical transport (EMT) team and the history written by the admitting physician or nurse.
Once a fracture is confirmed radiographically, the most significant first assessment is whether the fracture is “open” or “closed” – or in other words, whether the fracture is associated with a break in the skin. A useful and ubiquitously used classification system is the system of Gustilo and Anderson. Under this system, a Grade I open fracture is described as having an associated open wound less than 1 cm with minimal soft tissue injury and a clean wound bed; these open fractures are generally thought to result from a sharp spike of bone penetrating the skin from inside to out. Grade II injuries have an open wound greater than 1 cm in length with a moderate associated soft tissue injury, and the wound bed is moderately contaminated. Grade III open fractures generally have wounds greater than 10 centimeters in length, but these injuries are further subclassified as type “A” – with minimal stripping of the soft tissues surrounding the bone, type “B” – with extensive soft tissue stripping probably requiring a soft tissue flap to close or cover the wound, or type “C” – with an associated major vascular injury.
Falls, pressure sores and IV therapy-related events may lead to high treatment cost, prolonged suffering, and denied reimbursement for hospital care. They may even cause to the patient’s death. Healthcare providers are increasingly aware of the clinical and financial risks. Attorneys are increasingly seeing plaintiffs alleging deviations from the standard of care related to these events. These events often culminate in litigation.
Are you a legal nurse consultant, attorney or clinician? Analyzing Falls, Pressure Sore and IV Therapy Cases was written to help you understand:
- What causes these events
- What are the clinical results or damages
- How these problems are prevented
- How to analyze the liability
The text is chock full of practical wisdom, tips, explanations, and guidance for the analysis of these cases. It builds on the author’s experiences as an expert witness and legal nurse consultant since 1987.
Table of Contents
Chapter 1 Why Falls Happen
Chapter 2 Injuries From Falls
Chapter 3 Fall Prevention
Chapter 4 Liability for Falls
Chapter 5 Why Pressure Sores Happen
Chapter 6 Pressure Sore Injuries and Treatment
Chapter 7 Pressure Sore Prevention
Chapter 8 Liability for Pressure Sores
Chapter 9 Why Infiltration and Extravasation Happen
Chapter 10 Injuries and Treatment: Infiltration and Extravasation
Chapter 11 Prevention and Early Detection of Infiltration and Extravasation
Chapter 12 Liability for Infiltration and Extravasation
Chapter 13 Why Nerve Injuries from Venipuncture Happen
Chapter 14 Prevention and Liability Analysis of Nerve Injuries
Chapter 15 IV Catheter Embolism and Air Embolism: Causes, Treatment
Chapter 16 Liability for Air Embolism
Chapter 17 IV Catheter Sepsis
Chapter 18 Liability for IV Catheter Infections
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