Medical Mistake Claims - Simpson Millar LLP

Complications with Intravenous Infusions Caused by Undertrained NHS Staff

Author: Neil Fearn  Bullet  Dated: 31/05/2013

A consultation by the National Institute for Care and Excellence (NICE) has discovered that overworked and under trained NHS staff may be putting lives at risk when dealing with patients in need of an intravenous infusion (IVI).

What is IV therapy and what is it used for?

IV therapy is the infusion of fluid directly into a vein. It is an essential part of medical treatment as it is the fastest way to deliver fluids to correct any electrolyte imbalances and dehydration and medication, such as pain relief and antibiotics.

IV therapy is also used to deliver blood products and transfusions as well as parenteral nutrition to those people who are unable to eat. Simply put, it can be life saving.

However, incorrect management of IV therapy can result in extensive, and sometimes fatal, consequences.

The dangers of IV therapy

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE has explained how mistakes with IV therapy can lead to serious cases of medical negligence.

For example, if the wrong amount or composition of IV fluid is prescribed, then there is a risk of complications such as fluid in the lungs, dangerously raised or lowered potassium and sodium levels or nutrients such as glucose and even heart failure.

Extravasation injuries

Another, worrying aspect to the incorrect use of IV fluid/medicine therapy is an extravasation injury, which is when any medicine or fluid escapes into the surrounding tissue. Extravasation injuries are a potentially serious consequence of all types of intravenous therapy.

The degree of an extravasation injury ranges from mild skin reaction or blisters to serious soft tissue loss and scarring around nerves, joints and tendons. Severe damage can also result in necrosis, skin grafting and amputation above the dead tissue to prevent the spread of the tissue damage.

Extravasation injuries are more common and severe in children and neonates compared to adults, because they may not be able to localise or report pain. Elderly patients can be more at risk because of interference with the cannula when confused or agitated, reduced pain sensation and fragile skin and veins. Patients with communication difficulties are also more at risk of extravasation injuries going unnoticed.

The best treatment for extravasation is prevention. Most hospitals will have specific extravasation policies and procedures in place for the administration of IV fluids/medicine and the observation of the same. It is the nurse’s responsibility to know the hospital’s policy.

However, an extravasation injury should be treated as a medical emergency and immediate and early action must be taken by stopping the injection/infusion immediately to minimise the damage leaving the cannula in place.

Lack of training in IV fluid management

The NICE consultation has found that the risk of these serious complications is compounded when looking at the lack of training of some NHS professionals.

In particular, there is said to be a lack of training in IV fluid management before an NHS worker is fully qualified. NHS professionals are also said to be overworked and not able to give patients the attention they need. There is also a lack of agreement about which IV fluids are best, leading to a wide variation in the way that IV fluids are administered.

This leads to a worrying risk of medical negligence through IV mistakes.

NICE has now launched a consultation on new draft recommendations for IV fluid management. Guidelines on staff training in IV fluids and a widespread IV management policy are hoped to represent best practice for the NHS, and reduce the likelihood of medical negligence through mistakes with IV’s.

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