This case is located in Mississippi and involves a 60-year-old male patient who was recovering in a surgical ICU following a surgical procedure. During his ICU admission, the nursing staff caused an extravasation of IV fluid into the patient’s right hand. During the time range of the extravasation, the patient was likely sedated, intubated and restrained. The extravasation was likely a vesicant agent or a high concentration irritant agent, given the degree of tissue damage and necrosis caused. No physician was informed. The nursing staff dressed the wound with gauze, Kerlix and Silver Sulfadiazine. A plastic surgery consult was not requested until weeks later. The wound required multiple surgical debridements and skin grafts.
Question(s) For Expert Witness
- 1. How often do you treat IV extravasation of the hand?
- 2. What is the protocol for treating this injury?
- 3. Can a delay in treatment affect a patient's prognosis?
Expert Witness Response E-008516
I am very familiar with extravasation injuries in both adult and pediatric patients. Given that the patient was likely unconscious when the injury occurred, the responsibility for ensuring the security of his IV line was entirely on the medical staff. Once the patient’s injury was recognized, he should have been seen by a plastic surgeon immediately. I frequently treat these patients and would be happy to review this case.
Expert Witness Response E-008677
I see and treat 1-2 cases of IV extravasation per month. The treatment depends on the nature of the fluid extravasation. Each substance will require a different course of action. However, early intervention is key. Any delay could certainly impact the prognosis.