Patient is Injured by Contrast Fluid

Case Overview

This case takes place in Indiana and involves a patient with a past medical history of intravenous drug abuse. The patient was due to undergo a radiology procedure, and the patient’s PCP requested that a PICC line -as opposed to a standard catheter – be used to inject the contrast fluid. Instead of using a PICC line, as was ordered by the patient’s PCP, the radiologist elected to use a standard catheter. Because of the patient’s long history of drug abuse, the catheter ruptured the vein in which it was placed, and as a result a significant amount of contrast material entered the patient’s body. The patient suffered compartment syndrome and carpal tunnel syndrome, requiring additional treatments and causing permanent injury.

Questions to the Radiology expert and their responses

Do you have experience inserting PICC lines?

I have extensive experience inserting PICC lines.

Was a PICC line indicated in the case outlined in the above summary?

I am unclear about which 'radiology procedure' the patient was to undergo. I assume it was a contrast-enhanced CT scan. Based on this assumption, in most 'uncomplicated' patients, a PICC line is not necessary for contrast administration. A standard angiocatheter can be used most of the time. However, a patient with a past medical history of IV drug abuse represents a 'complicated' patient. Repeated peripheral access with infusion of non-medical substances can cause peripheral venous stenoses and occlusions. In that instance, it is neither unreasonable nor uncommon to request a PICC or other type of central venous catheter for contrast administration. So, if my assumptions are correct given the provided history, a PICC (or other central venous catheter) was indeed indicated.

About the expert

This board-certified expert currently serves as Assistant Professor of Radiology at a major university medical center and as Director of Interventional Radiology at a government-owned medical center. He earned his MD from Georgetown University and completed fellowship training in Vascular and Interventional Radiology at the University of Virginia Health System. As a member of the Radiological Society of North America and the Society of Interventional Radiology, this expert is very highly regarded in his field.

E-007952

Specialties:

Radiology