Improper Placement of IV Causes Fluid Leakage Under the Skin and Severe Skin Irritation

This case involves a patient who had a severe diabetic episode of hypoglycemia. When EMS arrived on the scene they placed an IV and transported her to the hospital. At the hospital, she was given another IV that infiltrated the underlying tissue, as it was not placed into the vein properly. The extravasation of fluid with D5W solution irritated the area around the IV puncture site to the point of skin necrosis.

Question(s) For Expert Witness

1. Would you have been able to determine if the IV was put in incorrectly and when it should have been noticed?

Expert Witness Response E-000129

If an IV infiltrates, meaning that the fluid got out of the vein and into the surrounding tissues, it will cause irritation. If the IV was documented to have infiltrated, and a solution that can cause "burns", such as D50W was administered, then a cause and effect relationship can be established. It should have been noticed quickly by the nurses, if an ampule of D50W is being actively pushed in by the nurse, as opposed to an IV drip, then it should been noticed immediately.