ER Nurse Misses Vein During IV Placement Causing Infiltration Burns

ByMichael Talve, CEO

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Updated onOctober 14, 2017

ER Nurse Misses Vein During IV Placement Causing Infiltration Burns

This case involves a twenty-three-year-old female patient who was seen in the emergency room for lower back pain after being involved in a car accident. The patient was started on an IV drip of normal saline by an ER nurse while she waited for the ER physician to examine her. When the physician arrived forty-five minutes later, the patient complained of severe pain and tightness around the site of the IV. The patient’s arm displayed local edema, skin blanching, skin coolness, severe pain, and leakage at the puncture site. It was determined that the patient sustained IV infiltration burns and had to undergo surgical decompression of the forearm to relieve the rapid pressure buildup in the subcutaneous tissue.

Question(s) For Expert Witness

1. Could any therapeutic intervention have been initiated as soon as the infiltration was noticed to prevent the need for surgical decompression?

Expert Witness Response E-000253

inline imageIf the signs and symptoms of infiltration are noticed, one should immediately stop the infusion and remove the catheter because continuing the infusion, despite the signs and symptoms of infiltration, will create the compartment syndrome scenario. A common intervention for infiltration is thermal management at the site. For certain nonvesicant drugs, applying heat to increase blood flow and the amount of interstitial tissue in contact with the fluid can dissipate the pressure. For hypertonic or hyperosmolar fluids, applying cold to restrict contact with additional tissue can be helpful as it limits the tissue affected by osmotic fluid shift. Another intervention is injecting an antidote. Hyaluronidase, a protein enzyme that breaks down the subcutaneous cellular components to allow fluid reabsorption, is probably the best choice, and several brands are available.

About the author

Michael Talve, CEO

Michael Talve, CEO

Michael Talve stands at the forefront of legal innovation as the CEO and Managing Director of Expert Institute. Under his leadership, the Expert Institute has established itself as a vital player in the legal technology arena, revolutionizing how lawyers connect with world-class experts and access advanced legal technology. Michael's role involves not only steering the company's strategic direction but also ensuring the delivery of unparalleled intelligence and cutting-edge solutions to legal professionals. His work at Expert Institute has been instrumental in enhancing the capabilities of attorneys in case preparation and execution, making a significant impact on the legal industry's approach to expert consultation and technological integration. Michael's vision and execution have positioned the Expert Institute as a key facilitator in the intersection of law and technology.

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