Thursday, September 27, 2012

Extravasation Malpractice-Protect Against It

  Protect Against It


Yahoo news report “The Law Offices of Kenneth A. Wilhelm uses expert testimony to prove medical negligence in the case of a day-old infant who suffered permanent injuries as a result of improper IV administration. The Law Offices of Kenneth A. Wilhelm, a New York personal injury law firm, has successfully obtained an $800,000 verdict on behalf of their client, a day-old infant, who suffered permanent scarring and injury Extravasation malpractice case: Law firm secures $800,000 verdict.

The child was admitted to the Montefiore Medical Center in the Bronx on Jan. 13, 2006, a day after he was born. The law firm filed a complaint in the Supreme Court of the State of New York, Bronx County (Index # 8785/2007) against the hospital alleging that the child, who was scheduled to undergo spina bifida surgery the following day, was not properly monitored by nurses at the hospital while he was receiving intravenous fluid in preparation for the surgery.”

This case as well as many other types of IV Therapy cases are won on the basis of medical negligence or malpractice.  So what is medical negligence? "Medical malpractice is professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of practice in the medical community and causes injury or death to the patient, with most cases involving medical error. Standards and regulations for medical malpractice vary by country and jurisdiction within countries. Medical professionals may obtain professional liability insurances to offset the risk and costs of lawsuits based on medical malpractice"

So what are the standards for Infusion Therapy? Standards are recommended by the

 Infusion Nurses Society

Infiltration and extravasation are complications that can arise with the administration of intravenous therapy solutions and or medications. They typically involve unintended leakage of a  solution or medication into the surrounding tissue. Severity of injury ranges from local irritation to amputation. While immediate action using appropriate measures (ie, dilution, extraction, antidotes, and supportive treatments) can decrease the need for surgical intervention, many injuries may be prevented by following established policy and procedures based upon the Infusion Nurses Society Standards of Practice.

Infiltration is the inadvertent leakage of a nonvesicant solution into surrounding tissue; whereas extravasation is the inadvertent leakage of a vesicant solution into surrounding tissue.
An extravasation injury can arise while administering IV solutions high in osmolarity and Ph as well as caustic medications and may lead to devastating consequences if not properly diagnosed. A health care provider's failure to assess and treat this complication in a reasonable time-frame can lead to further devastation and injury to the patient as well as medical malpractice lawsuit.

Failure to properly diagnosis an extravasation injury may lead to:
  • loss of limb;
  • need for amputation;
  • disability; and/or
  • disfigurement.


Heat and Cold 

  • Heat induces vasodilation, increasing drug distribution and absorption and decreasing local drug concentrations
  • Cold causes vasoconstriction, localising the extravasation and allowing time for local vascular and lymphatic systems to disperse the agent.
  • With the exception of vinca alkaloids, topical cooling seems to be more effective than topical warming in the management of cytotoxic and non-cytotoxic vesicants




Introduction to Intravenous Therapy for Health Professionals By Fulcher, Eugenia M./ Frazier, Margaret Schell (Google Affiliate Ad) 




  2. Infusion Nurses Society. Infusion nursing standards of practice. J Infus Nurs. 2006;29(1)(suppl):S1-S92