Abstract

A patient experienced complications following insertion and use of 2 similar vascular access devices with tip termination apparently in the subclavian veins. The thrombotic complications that developed were identified and reported in the first incident (a) as an occluded catheter, and then (b) as bleeding complications with delayed reporting for 8 days with the second catheter. The result was symptomatic deep vein thrombosis, thoracic outlet syndrome, and permanent nerve damage in both right and left extremities used for the venous catheter. The patient brought charges of malpractice against the hospital, the home care company, one nurse, and the manufacturer, alleging permanent nerve damage, venous occlusion, and chronic pain syndromes associated with both upper extremities. During the subsequent trial, evidence of permanent loss of function to the patient's left arm and chronic pain to both arms was presented through documentation of loss of fitness and inability to perform actions necessary to his chosen career as a pilot. The pain and loss of function were directly related to terminal tip placement of the catheter and care provided in conjunction with the venous catheter. The jury trial awarded the patient a final judgment of $7.15 million, with the hospital 55% liable and 45% liability among the other defendants. The jury also added some hospital physicians to the liability of the treatment and resulting patient harm. Nurses caring for patients have a duty to assess and evaluate the patient for complications on an ongoing basis, administer the prescribed therapy, and consistently provide communication with the primary physician specific to the assessment findings. A specialized nurse or certified intravenous nurse (CRNI) is held to a higher level of knowledge, understanding, and function. In this case, a CRNI was providing care for the patient both through hospital and outpatient home care services. Medical professionals and hospitals can reduce the likelihood of liability related to adverse events with venous catheters by acquisition of current education on the devices they insert and maintain; by updating and adhering to policies and procedures based on Standards of Practice and manufacturer instructions for use; by thorough documentation of care; and by conscientious reporting of patient clinical signs and symptoms. The goal of achieving safe patient care with vascular access devices is only possible through consistent education processes with all associated clinical staff.