Improperly Administered IV Causes Significant Infection

    Hospital Medicine Expert WitnessThis case involves a middle-aged male patient in Iowa who presented to the emergency room for atrial fibrillation as well as a suspected heart attack. The patient underwent treatment with the placement of a coronary stent, and was placed in a hospital room to recover from the procedure. During this time, the patient was given an IV drip of saline solution. The nurse allegedly failed to locate the IV needle in the patient’s vein, who immediately complained of a burning pain at the injection site. Over the next week, the patient developed a gangrenous infection at the site of the injection that eventually necessitated the amputation of his left hand.

    Question(s) For Expert Witness

    • 1. Do you routinely treat patients like the one described here?
    • 2. Can you opine on the standard of care for such patients?

    Expert Witness Response E-001692

    I routinely treat patients such as the one in this case, as IV infiltration is unfortunately a fairly common occurrence. When it occurs, based on the type of fluid that has extravasated, it is important to consider the possibility of developing compartment syndrome in the digits and having vascular surgery consult asap. By having timely surgical intervention if the patient has compartment syndrome, there is a higher likelihood of limb salvage. Without surgical intervention, the compartment syndrome will invariably lead to digital gangrene and amputation. Considering the possibility of peripheral vascular disease existing in this patient, it behooves the primary doctors of this case to immediately consult vascular surgery to consider that compartment syndrome – if that was the patient’s actual diagnosis – superimposed on a backdrop of pre-existing vascular disease is a bad combination that will likely result in the outcome we see here without the surgical intervention of a qualified vascular surgeon.

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