Patient Dies From Catheter Puncturing Her Heart

This case involves a patient at a hospital who underwent gastric bypass surgery in an attempt to reduce her weight. The anesthesiologist placed a central venous pressure (CVP) catheter into the patient’s right internal jugular vein that was threaded down to rest in a blood vessel above her heart. The CVP catheter at some point punctured the patient’s heart and became embedded in a portion of her heart muscle. This caused the fluid from the IV to pass into the pericardial sac rather than into the intended blood vessel. This caused the patient to go into cardiac arrest. The nurse on duty was not able to persuade the charge nurse to summon the patient’s doctor until that evening. The patient was brought into emergency surgery and died soon afterward. The patient’s family sued the hospital claiming that the nurses on duty were negligent in not detecting the patient’s deteriorating condition and notifying her doctors of her condition at an earlier time.

Question(s) For Expert Witness

1. Can the family of a patient who dies after a catheter punctures her heart during surgery sue the hospital if the nurses on duty failed to detect the patient’s condition in time?

Expert Witness Response

When the catheter punctured the patient’s heart, the catheter may have run down the internal jugular vein into the heart and through the heart wall with the tip just beyond the heart wall into the pericardial sac. This caused a continuing accumulation of fluid in the pericardial sac that created an increasing pressure on the patient’s heart, which caused her to go into cardiac arrest. When there is an accumulation of fluid in the pericardial sac, this is called cardiac tamponade, which is a life-threatening condition characterized by increased CVP readings, an increased pulse rate, and decreased blood pressure. Usually, cardiac tamponade is a reversible condition if detected and treated early enough. The nurses treating the patient had a duty to interpret the patient's condition and to notify the doctor about the tamponade so that he had sufficient time to properly diagnose and treat the condition before it became irreversible. The nurses did not meet the proper standard of care in this case, because they failed to detect the patient’s increased pulse rate and her falling blood pressure.