EXECUTIVE SUMMARY
A significant number of IVs fail and cause patient harm. Malpractice attorneys are increasingly pursuing these lucrative claims.
- Monitoring is key to preventing serious patient harm.
- IV failure cases are difficult to defend.
- Individual nurses and physicians often are named in these cases.
Up to half of IVs fail. In many cases, those failures cause serious harm to the patient, ranging from medication dosing errors to amputation and death. Malpractice cases based on IV failures are a growing concern for hospitals and health systems.
The authors of a 2018 study reported failure rates of up to 50% for peripheral intravenous catheters (PIVCs), the most used invasive medical device.1 In November 2022, a jury awarded a patient $11 million in a medical malpractice lawsuit against an Indiana hospital when an IV failure resulted in a below-the-knee leg amputation, according to Cohen & Malad in Indianapolis, which represented the plaintiff. The patient had been admitted for nausea and vomiting, and a nurse placed an IV in his foot.2
Healthcare risk managers should expect to see more malpractice claims related to IV failures, says Russ Nassof, JD, an attorney and risk consultant in Henderson, NV. He frequently works with IV failure issues.
“The problem of IV failure in healthcare is really a sleeping giant,” Nassof says. “Anytime you go into a hospital, the first thing they do is they give you an IV, and it’s like it is no big deal. What people don’t know is that more than half of these peripheral IVs fail for a whole variety of reasons. But in their failure, they also can create a lot of problems.”
Infiltration and extravasation involve the leakage of fluid from the IV to surrounding tissue and can cause serious complications.
“One in every six IVs fails due to infiltration, so it’s really a significant risk. Lawyers have started to pay attention to this, and I think this has become kind of a big deal recently because people are becoming more aware of it,” Nassof says. “There is this kind of perfect storm brewing in healthcare around these catheter failures.”
Monitoring of IVs Required
Clinical standards require the IV be checked for infiltration or extravasation regularly, with the frequency dependent on the nature of the substance infused, but Nassof says the monitoring usually is not performed properly.
“This was bad before COVID, but post-COVID — what’s happened in healthcare is that we don’t have enough nurses. On top of that, the nurses that we have are not nearly as competent as the ones that we used to have,” Nassof explains. “A lot of people have retired, a lot of the older nurses have gone, a lot of people got burned out. There’s a whole lot of reasons why the quality of care that you’re getting post-COVID isn’t nearly what you got pre-COVID.”
The legal standard is not about prevention in these cases, Nassof notes. Venous puncture leading to infiltration or an extravasation can happen so quickly — and any time after the initial insertion — that they are virtually impossible to prevent. The legal standard concerns a failure to monitor.
“If you fail to identify and promptly and properly treat an issue, that’s when your liability comes up,” Nassof says. “You’ve stuck this person with a catheter — it seems fine at first, but later they’ve got a problem that you don’t know about, and all of a sudden your patient’s arm swells up to the size of a balloon, or it starts turning black and blue.”
Nurse Training at Issue
Many IV problems occur with children, the elderly, and patients in the ICU who cannot report an issue, Nassof notes. Pain and swelling take time to manifest but can be detected before the problem becomes critical with proper monitoring.
“A lot of the reason for these problems is that our nurses today are not really trained. They don’t have good competency with respect to actually working with patients, inserting catheters. It’s kind of like they think anybody can insert a peripheral line, and that’s not really the case,” Nassof says. “They don’t insert them in the right place, they don’t insert them properly, and they don’t secure them properly.”
Following clinical standards and using bundles is critically important to prevention, Nassof says. Because monitoring is so important, some hospitals are turning to emerging technology that can monitor constantly for infiltration and extravasation.
In addition to the hospital, nurses and physicians are increasingly named in these extravasation lawsuits. “The problem is that if you get one of these claims, it’s almost always going to be resolved in favor of the patient because the hospital has very little defense for this, usually. They have no documentation, they don’t really know what’s happened, and nobody has been monitoring the site,” Nassof says. “The hospitals almost always settle these claims. The data on this is hard to get because the hospitals settle these things and sweep them under the rug very, very quickly.”
To underscore the malpractice risk, Nassof notes a quick Google search for infiltration and extravasation attorneys will bring “pages and pages and pages of these guys, just looking for these things.”
REFERENCES
- Piper R, Carr PJ, Kelsey LJ, et al. The mechanistic causes of peripheral intravenous catheter failure based on a parametric computational study. Sci Rep 2018;8:3441.
- Cohen & Malad, LLP. Jury awards patient $11 million against Methodist Hospital Northlake Campus for medical malpractice. November 2022.
SOURCE
- Russ Nassof, JD, RiskNomics, Henderson, NV. Phone: (480) 315.1100. Email: [email protected].
Up to half of IVs fail. In many cases, those failures cause serious harm to the patient, ranging from medication dosing errors to amputation and death. Malpractice cases based on IV failures are a growing concern for hospitals and health systems.
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