3 big procedural errors that could get you sued
An injured nerve upon placement of an intravenous (IV) line, usually the radial nerve on the patient's dorsal wrist. A retained foreign body during IV removal, or fractured IV catheter upon removal. A misplaced Foley catheter, usually inflated in the ureter instead of the bladder.
These are three common reasons for an emergency nurse to be named in a lawsuit, says John Burton, MD, residency program director for the department of emergency medicine at Albany (NY) Medical Center.
In some cases, it can be difficult to prove whether procedural complications occurred because of something the ED nurse did incorrectly, or due to the patient's own actions, notes Burton. "The Foley catheter is always the best example," he says. "Did the Foley end up in the ureter because the nurse placed it there, or because the patient kept pulling on it? Where you should place the blame? While this issue may seem difficult to believe, I've seen this question a few times in recent years."
To reduce risks when placing Foleys and IVs, Burton says to document placement, site, and any adjustments and periodic inspections made.
Katie Ryan, RN, BSN, director of the ED at St. Rose Dominican Hospitals — San Martin Campus in Henderson, NV, says, "Every emergency room nurse can place an IV or insert a Foley catheter with their eyes closed. However, the sheer volume with which we perform these procedures every day may lead us to forget the potential harm we can cause our patients."
To reduce risks, Ryan says to do the following:
• Educate patients on what to expect when the procedure is under way.
"Most importantly, we must ask our patients to let us know if there is unbearable discomfort," says Ryan. Pain after the Foley or IV has been inserted should be thoroughly evaluated, as an IV with a good blood return that is causing extreme pain might be indicative of a catheter that is too close to or even damaging the nerve, explains Ryan.
• For Foley catheters, if there is resistance when inflating the balloon, the procedure should be stopped.
If the Foley was inserted to the hub and there still is pain with balloon inflation, the urethra might be damaged, strictures might be present, or there might be some other anatomical issues, says Ryan. "Forcing balloon inflation carries high risk for aggravating or causing damage to the urethra," she says.
• When discontinuing devices, inspect the catheters and verify that the entire catheter is present.
"If any part of the catheter appears to be missing, the physician should be notified," says Ryan. "Documentation of the removal of these two types of catheters should include that the catheter was inspected at removal and found intact."
Avoid unsafe practice during IV insertion The safest practice during IV insertion is to never re-sheath your cannula, says D.D. Fritch-Levens, RN, BSN, administrative resource nurse for emergency services at Children's Healthcare of Atlanta. "Removing the needle and reinserting it into the cannula destroys the integrity of the cannula and increases the risk of fragmentation-causing emboli," she says. |
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