When asked to imagine a hospital patient and the equipment surrounding them, it’s likely that an IV line is one of the first items you envision, and for good reason. Providing important control over dosage, intravenous catheters are essential for medication administration and fluid regulation. However, because a drug’s absorption rate is very high when injected intravenously, special attention is required both before and after administration, otherwise results could be fatal.[1] Unfortunately, improper IV administration and monitoring occurs frighteningly often; one study found that 69.7% of intravenous administrations had at least one clinical error, and a fourth of these were considered serious errors.[2] Wondering how to better assist clients involved in IV-related malpractice suits? Here’s a breakdown of the risks posed by IVs, the common causes of these risks, warning signs, and prevention methods to decrease error rates in hospitals.
Potential IV-related injuries:
- Infection: If the site of injection is or becomes unclean, or if the catheter itself carries bacteria, infection can occur. If not attended to, this infection can travel into the bloodstream and cause a severe infection through the body.
- Infiltration: Infiltration occurs when the medication from an IV leaks out into surrounding soft tissue. Instead of being infused into the bloodstream, the medicine spills outside the intravascular space; this is typically caused by poor needle placement and can lead to tissue and vein damage.[3]
- Air embolism: An air embolism refers to the phenomenon of air bubbles entering a vein. If air gets into a syringe or IV medication bag, the IV line will run dry, causing air bubbles to travel through the vein to a patient’s heart or lungs and block blood flow.[4] Though rare, an air embolism can cause problems as severe as a heart attack or stroke.
- Phlebitis and blood clots: Another danger IVs pose to blood vessels is phlebitis, or inflammation of the veins, which can also occur from a poorly administered IV catheter. Phlebitis can cause blood clots, which can block important blood vessels, causing tissue damage or even be life threatening.
- Medication errors: Some of the most common medical malpractice cases revolve around medication errors, so it should come as no surprise that wrong intravenous rate, mixture, or volume are some of the most frequent IV-related injuries. Giving a drug at a faster rate than recommended, giving a patient the wrong drug or dosage, or giving two drugs that are incompatible together all fall into this category.[5]
Common causes:
- Poor needle placement
- Miscommunication about a dosage or medication
- Catheter inserted at an improper angle or position
- Multiple failed attempts at inserting the IV, causing “pinprick damage” to surrounding tissue or veins
- Use of oversized catheter
- Administer lacks knowledge of high-risk medication
- Applying fixation tape or dressing negligently, causing the IV to slip out
- Failing to adequately monitor the IV flow rate, causing too high a flow rate and therefore too high of pressure for the catheter to remain in the vein
- Pressure, pulling, friction, or pushing of the IV, IV line, or catheter
- Knowingly using an inappropriate, weakened, ruptured, or otherwise compromised vein to support the catheter[6]
Signs of IV negligence or improper administration:
- Swelling of soft tissue surrounding the IV
- Change in skin color or temperature
- Bruising
- Generally abnormal skin appearance – stretched, taut, or bulging
- Fluid or blood is leaking from the IV site
- Pain is present or increasing
- IV infusion has stopped or significantly slowed
- Bandages, dressing, tape, or other fixation at the IV site is damp or wet[7]
Prevention methods
- Know warning signs: Patients should notify their caregiver the moment one of the above signs is noted. Similarly, caregivers should monitor a patient’s IV, a patient’s reaction to the medication, and the skin surrounding the injection site.
- Establish safety guidelines: To reduce negligence, medical institutions can establish safety guidelines for the injection of high-risk medications.[8] Sterile equipment should always be available and used, and guidelines regarding best practices can reinforce compliance.
- Check and double-check: Before giving an intravenous medication, nurses should have no questions regarding the dosage, medication type, or speed of administration. Patient identification should be clear, and any communication – written or oral – with prescribing doctors should be specific and correct.
- Institute routine training: One study found that with each year of experience, a nurse’s risk of error was reduced by 10.9% and serious error was reduced by 18.5%.[9] Ongoing education about proper IV administration is essential, especially for new nurses, and due to rising numbers of medication varieties, nurses may lack the appropriate knowledge to understand medication interactions if not given regular updates.[10]
Intravenous medication administration is an extremely common medical procedure, and it is critical that it is done safely and correctly. If you need additional expertise analyzing medical records and reports regarding an IV-related injury, don’t hesitate to contact us for a consultation.
[1] Kim, Miran and GyeongAe Seomun, “Errors in high-risk intravenous injections administered by nurses: the causes according to healthcare professionals,” HeathScienceJournal.gr, 2011, http://www.hsj.gr/medicine/errors-in-highrisk-intravenous-injections-administered-by-nurses-the-causes-according-to-healthcare-professionals.php?aid=2735
[2] Westbrook, Johanna, Marilyn Rob, Amanda Woods, and Dave Parry, “Errors in the administration of intravenous medication in hospital and the role of correct procedures and nurse experience,” NCBI.gov, Dec 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228265/
[3] Case-Lo, Christine and Aleah Rodriguez, “Intravenous Medication Administration: What to Know,” healthline.com, Nov. 20, 2016, http://www.healthline.com/health/intravenous-medication-administration#side-effects6
[4] Ibid
[5] Westbrook, Rob, Woods, and Parry, “Errors in the administration”
[6] Greer, Thomas, “Injuries Caused by IV Mistakes: Tennessee Medical Malpractice Lawyers Explain Signs and Liability,” Baileygreer.com, Aug. 19, 2013, https://www.baileygreer.com/injuries-caused-by-iv-mistakes-tennessee-medical-malpractice-lawyers-explain-signs-and-liability/
[7] Ibid
[8] Kim and Seomun, “Errors in high-risk intravenous injections”
[9] Westbrook, Rob, Woods, and Parry, “Errors in the administration”
[10] Kim and Seomun, “Errors in high-risk intravenous injections”