Intravenous (IV) therapy is a cornerstone of modern medicine, used to deliver fluids, medications, and nutrients directly into a patient’s bloodstream. While generally safe, IV administration carries risks, notably infiltration and extravasation. Both conditions can lead to severe injuries, and when they result from negligence, they can form the basis for medical malpractice claims. As a Texas medical malpractice attorney, I think it’s important for patients to understand these issues, the signs to watch for, and the legal recourse available if negligence is at play.
What Is IV Infiltration and Extravasation?
IV infiltration occurs when the IV fluid or medication unintentionally leaks into the surrounding tissues instead of entering the vein. This can happen when the IV catheter dislodges or if the IV line punctures through the vein’s wall. The fluid involved in infiltration is typically non-vesicant, meaning it doesn’t cause tissue damage, but it can still lead to swelling, discomfort, or in severe cases, compartment syndrome.
IV extravasation, however, is the term used when a vesicant — a substance capable of causing blistering or tissue damage — escapes from the vein into the surrounding tissue. Common vesicant drugs include certain chemotherapy agents, which can cause significant harm if they do not go directly into the bloodstream.
We’re currently working on a case where a major Houston hospital provided Cisplatin chemotherapy by an IV line. There was a problem with the IV line and this powerful vesicant medication leaked into his arm, causing terrible swelling and redness, and permanent loss pain and other problems.
Proper Handling and Signs of Complications
On of the issues in our current case is site selection. The nurse started the IV arm in the fold of the elbow. Our infusion nurse expert explained that this was a big mistake. Nurses and doctors should choose an appropriate site for IV insertion, avoiding areas where the catheter might be disturbed by joint movement or where the vein might be too small or fragile.
Once the IV is started, it needs to be secured in place. The IV should be well-secured with tape or other stabilization devices to prevent it from becoming unseated or detached.
To minimize the risk of complications, nurses should regularly monitor the IV site and line. Continuous assessment of the IV site is crucial. This includes checking for signs of infiltration or extravasation, like swelling, pain, or changes in skin color. If there’s a problem, the nurse should notify a doctor and get medical treatment. It is important that hospitals hand-off communications so the right hand knows what the left hand is doing.
Signs Something Might Be Wrong
As a patient or family member, there are some things you can look out for that should trigger a request for evaluation and help. Infusion pumps generally have alarms, but they don’t always alert for every problem.
Speak up and tell the nurse or physician if you see:
- Swelling or Pain: Any noticeable swelling or sudden onset of pain around the IV site can indicate infiltration or extravasation.
- Coolness or Discoloration: The skin around the IV might feel cooler than surrounding areas or become discolored (red, purple, or pale).
- Leaking or Bleeding: Visible fluid leaking from the IV site or unexpected bleeding can be a clear sign of an issue.
- Decreased Flow Rate: If the IV fluid isn’t flowing as expected, it might be because the catheter is no longer in the vein.
Injuries and Damages from Negligent Handling
When IV infiltration or extravasation is mishandled or overlooked, the consequences for the patient can range from mild to catastrophic. The damages in a particular incident depend on the medication or substance running in the IV, how long it infiltrated or extravasated, and the tissue or structures affected.
- Tissue Damage: Infiltration can cause mild swelling, but extravasation might lead to burns, blisters, or necrosis (tissue death).
- Nerve Damage: Prolonged exposure to extravasated fluids can compress or damage nerves, leading to temporary or permanent loss of function.
- Compartment Syndrome: This dangerous condition occurs when pressure within the muscle compartments builds to dangerous levels, potentially leading to muscle and nerve damage. In severe cases, this may require surgery to release the pressure.
- Infection: If not managed properly, an infiltrated IV site can become a breeding ground for infection.
In addition, patients who suffer from extravasation or infiltration injuries often experience pain, suffering, and mental anguish.
Legal Issues in Medical Malpractice Cases
Under Texas law, IV infiltration or extravasation negligence is a health care liability claim. An experienced medical malpractice lawyer helps patients (plaintiffs) provide the required elements of a medical negligence claim.
- Duty of Care: Doctors and nurses owe a duty to patients to administer IV treatments competently and consistent with the standard of care.
- Breach of Duty: This is shown when the care provided deviates from the accepted standard of care. For instance, if the nursing staff fails monitor the IV site or respond to signs of infiltration it’s a violation of breach of duty. Under Texas law, testimony concerning the standard of care and breach requires an expert witness, which may be a physician or nurse, depending on the circumstances.
- Causation: The breach of the standard of care must cause the injury. Under Texas law, this requires expert testimony from a physician.
- Damages: The patient must have suffered actual harm — physical, mental anguish, or financial.
Types of Damages
Broadly speaking, Texas law allows two categories of compensation or damages in medical malpractice cases.
Economic damages are not capped by law and include things like past and future medical expenses and past and future lost wages or earning capacity.
Non-economic damages are subject to tort reform caps. They include things like pain and suffering, emotional distress, and loss of enjoyment of life. In Texas, there’s a cap on non-economic damages in medical malpractice cases, which can affect the compensation amount. An experienced Texas medical malpractice attorney can explain how they work.
Be sure to read FAQ: When does a medical mistake amount to medical malpractice in Texas?
Legal Process in Texas
If you’ve been seriously injured by an IV extravasation or infiltration event, then it’s important to remember that there’s only a limited amount of time to pursue your claim. In general, there’s a two-year deadline or statute of limitations from the date the injury was discovered or should have been discovered to file a medical malpractice claim.
There’s a lot of work required to get a medical negligence case ready for filing. For instance, Texas tort reform laws require medical malpractice plaintiffs to produce written expert reports early in litigation — just 120 days after a defendant files an answer in the lawsuit.
In a notable case, a patient in Texas received an $11 million award after losing a leg because of complications from IV infiltration. The injury was severe because the medical and nursing staff didn’t adequately monitor the IV site, leading to untreated extravasation.
Another case involved a patient who suffered from IV extravasation during chemotherapy, resulting in permanent tissue damage. The legal action highlighted the negligence in monitoring and responding to the early signs of leakage.
IV infiltration and extravasation are serious complications that can lead to significant health issues if not addressed promptly and correctly. Patients need to be vigilant about observing their IV sites, and hospitals, doctors, and nurses must follow the standards of care. When negligence leads to injury, Texas law provides a framework for victims to seek redress through medical malpractice claims.
If you or a loved one has experienced such an injury, consulting with a knowledgeable attorney can help navigate the complexities of medical malpractice law, ensuring you receive the justice and compensation you deserve. Remember, the key to successful management of IV therapy lies in prevention, early detection, and immediate action.
