Case Overview
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.
Questions to the Cardiology expert and their responses
Could any therapeutic intervention have been initiated as soon as the infiltration was noticed to prevent the need for surgical decompression?
If 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 expert
This expert is a board certified adult nurse practitioner who has been in clinical practice as an NP for 12 years. She has considerable experience prescribing Levaquin in patients with both normal and abnormal renal function. She has practiced both in a clinical and academic setting throughout her career.
E-000253
Specialties:
Questions to the Nursing expert and their responses
What is the standard of care when placing an IV line?
When placing an IV, we clean the site and place the line. We then check for blood return and flush, making sure it is not painful for the patient or causing a lump under the skin.
How does a nurse know if an IV line is placed correctly?
If an IV is placed correctly, it flushes with ease, has blood return(not always), and will not be painful to flush. It will also not bubble under the skin when flushed.
About the expert
This registered nurse expert is currently practicing at a hospital in North Carolina and has experience across a broad range of acute care settings, including emergency medicine, trauma surgery, cardiac surgery, stroke care, step-down units, and medical-surgical nursing. The expert holds an Associate Degree in Nursing from Wake Technical Community College and maintains Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) certifications. Prior to becoming an RN, the expert worked as a certified medical assistant in an urgent care setting. Their clinical background includes managing patients with congestive heart failure, atrial fibrillation, and other acute medical conditions, making them well-suited to address nursing standards of care, patient monitoring, emergency treatment, and inpatient hospital care. The expert has participated in six case reviews but has not yet been deposed or testified at trial.
E-1027234
Specialties:
Questions to the Nursing expert and their responses
How often do you care for patients who require IV placement in an inpatient setting?
Statistically, the majority of admissions come from the ED. As a result, I care for patients who need IV placement (and are eventually admitted inpatient) on a daily basis.
What is the standard of care with regard to IV placement and monitoring?
With IV placement, placement should be done using aseptic technique and using the size bore necessary for patient's acuity. Standard of care is to make sure the IV is patent before any IV push, and to monitor patency of the line during any fluid/med infusion.
About the expert
This expert has over 10 years of experience in the field of nursing. She earned her BS in biology from Kennesaw State University and her BSN from Georgia Southwestern University and has extensive experience as an emergency room nurse. Today, she is a licensed registered nurse and formerly served as a staff nurse in the emergency department of Tift Regional Medical Center and Emory Hillandale Hospital. Currently, she is an emergency room charge nurse and staff registered nurse, a staff nurse for surgical services, and a house supervisor, all for the same regional hospital in Georgia.
E-281746
Specialties:
