A long term care pharmacy contracts with a vascular access team to place PICCs in skill nursing facilities. The access team only uses PICC catheters which are trimmed to a midline and a patient has a negative outcome. Who is liable?
Should a PICC catheter labelled as such be trimmed as a Midline?
Does any one know of a case where a patient was sent to the hospital from a skilled nursing facility with a PICC catheter trimmed as a midline and a negative outcome occurred?
I have not had such a case, but it is conceivable that one could happen. I am thinking about severe infiltration or even thrombophlebiits producing nerve compression at midline tip location. Or extravasation producing a deep severe necrotic ulcer. The patient has permanent damage due to nerve damage causing CRPS or extravasation requiring surgical debridement with some loss of arm function. No case can be predicted and each case is always decided on the facts specific to each case. Based on my experience with review of legal cases, I think the attorneys would name both the inserting nurse, the insertion company, all nurses who administered medication/fluids through the catheter, and the nursing home and probably the infusion pharmacy. There is no way to determine who would be liable without going through the entire process. The strength of the case may drive the defendants to agree to a settlement prior to trial. Even with a good strong case and the facts on the side of the plaintiff (patient), if it goes to a jury trial, that jury could still decide in favor of the defendants. There is no way to predict who will be held liable. Sorry that is just the nature of our legal system. I have seen it go both ways. Yes, that catheter should be labeleld in multiple places that it is a midline and not a PICC. All nurses should know what they are dealing with and this would be responsibility of the nursing home to do this education. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
in January I placed a PICC in a patient with a large DVT in his right axillary to innominate. He came in with a "PICC" that was actually midclavicular, of course it had been used as a central placement. I was on a PICC travel contract and had to move on but had the same question and real concern for the outcome of this patient. He is a young man in rehab and this DVT has set him back considerably. I feel terrible for him.
There has been a major lawsuit involving a midclavicular tip location from a catheter labeled as a PICC that resulted in more than a $7 million judgement for the plaintiff. Vein thrombosis, produced such severe edema, causing nerve compression and CRPS. Lifelong pain management ruined a new career as an airline pilot. This case was published in JAVA but don't have the reference handy. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
that is truly heartbreaking Lynn. It motivates me to work harder for vascular access education. We MUST work to change common practice to best practice.