This case involves an overweight 55-year-old woman who was admitted to the hospital with complaints of chest pain. On the same day, she underwent aortic valve replacement and coronary bypass surgery. An IV was started in her arm and remained in her arm for a week. No fluids or medications were administered to the patient through the arm IV during this time period. During this time, the patient frequently complained of pain in and around the IV. It was alleged that no measures were taken at that time to stop the pain. The patient finally requested that the IV be removed. Following IV removal, the patient was diagnosed with sepsis, allegedly due to the line. The patient died secondary to the sepsis.
Question(s) For Expert Witness
- 1. What quality control standards are implemented for post-operative cardiac patients to prevent complications such as sepsis?
- 2. During a typical nursing shift on the floor if a patient complains of pain what is the standard of care for reporting and intervening on the patient's complaint?
Expert Witness Response E-166621
I have taken care of postoperative patients that have had aortic valve replacements and coronary artery bypass surgery, similar to the patient in this case. I have also taken care of patients with sepsis. When an IV is placed, it is protocol for the date and time the IV was inserted to be placed on a small sticker next to the IV site. Usually the initials of the person who inserted the IV are also located on this sticker. For a basic peripheral IV, the protocol is to leave the IV in place for no longer than 3 days. If the patient continues to need IV access, then a new one must be placed. Depending on hospital policy, these IVs should be checked by the RN every shift and as needed if the patient complains of discomfort with the IV. The nurse should be looking for signs/ symptoms of infection/infiltration. If a serious infection is suspected, the catheter should be removed, and the tip should be cut off and sent to a lab for testing. In this particular case, this IV should have been removed on day 3 to reduce the risk of infection. When the patient complained, the appearance of the IV site should have been documented along with the patient’s complaints. The IV should have been removed and the provider notified.