Patient is Injured by Negligent Port Implantation

This case takes place in Nebraska and involves a male patient who was diagnosed with a rare blood disease, for which he was receiving medical treatment. A port was to be placed to help administer the needed drugs. During the catheter placement surgery, the physician accessed a large vein but could not get the access that he needed – he then used an alternative approach that was apparently successful on the first try. Some weeks later, the patient returned to hospital for the first round of therapy. A nurse placed a syringe needle into the port and pulled the syringe plunger back to draw blood and informed the patient that it was working properly. However, the patient informed the nurse that he did not see any blood return. Nevertheless, the nurse proceeded with the therapy. Despite the fact that the man repeatedly told the nurse that he was in severe pain, the nurse continued to administer the treatment. When the patient left the hospital that afternoon he was in pain which was worsening as time went on. It became increasingly difficult for the patient to breathe, at which point he was taken to the emergency room by his wife. The patient presented to the ER with pain in his chest, where it was discovered that a large amount of the drug administered during his treatment had pooled within the tissues in his chest.

Question(s) For Expert Witness

1. Do you insert these ports? If so, how often?

2. What measures should be taken to ensure that the port is correctly positioned?

Expert Witness Response E-004704

I have placed PortaCaths in the past but I don't believe I have ever placed this brand.During the placement of the port they would have inserted a needle followed by a wire.The needle would have been removed and the dilator placed over the wire.The wire and dilator would have been removed and the catheter placed through the peel away sheath.This could have been done with or without fluoroscopy to confirm wire placement.After placement of the catheter, they should have checked for blood return. Final position is confirmed by X ray or fluoro at the end of the procedure.