Patient Suffers Hemorrhage Following Femoral Artery Cannulation Due to Inadequate Monitoring by Medical Staff

This cardiovascular perfusion case involves a sixty-two-year-old female patient who presented to her primary care physician with a long term history of worsening fatigue, shortness of breath and palpitations. An echocardiogram revealed mitral valve stenosis. The patient was initially managed conservatively with anticoagulant therapy and diuretics which alleviated many of her symptoms for a period of time. The patient later developed atrial fibrillation and was started on antiarrhythmics. The patient’s condition continued to decline and valve replacement surgery was deemed to be the best course of action. The surgery to replace the valve went ahead as planned without incident. The patient had a femoral artery cannula inserted for monitoring of vitals. Post-operatively she suffered a bleed at the site of the femoral artery cannula that went undiagnosed for several hours due to insufficient monitoring by the medical staff in charge of her recovery. By the time the hemorrhage was detected, irreversible damage had already occurred. The patient had a massive intraperitoneal bleed as a result of the femoral artery cannula. The patient was transferred to the ICU and remained in a critical condition for several weeks. She died 26 days after the procedure as a result of the post-operative complications.

Question(s) For Expert Witness

1. How do you make sure this type of incident does not occur?

2. What monitoring procedures should have been in place?

Expert Witness Response E-007154

Femoral artery cannulation is a valuable clinical tool used frequently in the assessment of critically ill patients and provides accurate, continuous blood gas, electrolyte and blood pressure monitoring. It is preferred over sphygmomanometer readings due to the higher level of accuracy, instant access to results and greater convenience for the clinician. It is a routine procedure, frequently carried out in acute settings. Arterial injury can be minimized through proper procedural techniques. Whilst serious complications such as injury to surrounding nerves, thrombosis, femoral artery dissection and hemorrhage can occur, these are very rare when the correct techniques and monitoring are employed. Securing hemorrhagic control of the cannulation site is a primary responsibility of the surgical team with consistent vigilance throughout the procedure. Normal monitoring would include routine checking for any loose connections, vascular compromise, comparison of the blood pressure reading to manual readings for ensured accuracy and regularly changing the tubing. Cannulation within the groin requires close assessment of fluid dynamics assuring that the cannula is positioned correctly and that excessive pressure does not develop which could lead to vascular disruption and dissection, either of which could lead to bleeding and malperfusion. Failure to implement sufficient monitoring could result in significant injury and morbidity to the patient as was the result in this case. Had this patient been adequately assessed and monitored the hemorrhage could have been avoided entirely or at the very least detected much sooner.