Death by IV Catheter: Air Embolism and IV Catheter Related Sepsis

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Presenter

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?

Related Reading

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.

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