Patient is Injured by Contrast Fluid

Joseph O'Neill

Written by
— Updated on October 13, 2017

Radiology Expert WitnessThis 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.

Question(s) For Expert Witness

  • 1. Do you have experience inserting PICC lines?
  • 2. Was a PICC line indicated in the case outlined in the above summary?

Expert Witness Response E-007952

I have extensive experience inserting PICC lines. 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.

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