Someone at our hospital inserted an IV in a lady who complained of severe pain at the site 30 minutes later. When the nurse D/C'd the IV he met some resistance and the tip of the catheter remained in the patients arm. Our hospital is considering pulling all the IV catheters of this make. I say that it was an issue with the nurse... I think he reinserted the needle when he couldn't get the catheter to advance well, weakened the tip, then it sheared off when he pulled it. It is a safety catheter. Has anyone ever heard of an IV catheter tip just spontaneously coming off? Thanks.
In 35+ years of infusion therapy practice, I have never seen or heard of spontaneous separation of all or part of the catheter on a short peripheral catheter. I think you are correct - this was related to technique when it was put in. The nurse probably reinserted the stylet back into the catheter and forced it through the catheter wall, thus leading to the catheter break when it was removed. I have seen this in clinical practice when I have been the educator/bedside preceptor, etc.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I agree with Lynn. I would bet that is exactly what happened although I doubt the inserting nurse would admit that he reinserted, something we all have been tempted to do. Hearing something like that definately reinforces the importance of NOT doing that!
One time I came across an IV that was covered in layers of silk tape. I decided to redress it with our usual Tegaderm dressing...good thing because when I removed all the tape, I found the entire catheter had disconnected from the hub and only the very tip of it was sticking out from the vein! The patient did not speak English so I said very loudly "DON'T MOVE" (that always helps when there's a language barrier!) Any way, I pulled the catheter out with a kelly clamp that I carry in my IV basket. I'm sure that was a defective catheter, I sent it to risk management, although we have never had a problem like that before or since.
I agree. The only time I've known of sheared catheters is when a clinician reinserted the needle into the cannula during insertion. The fact that the patient experienced pain within 30 minutes, the nurse noticed resistance when removing - all point toward inserter error. Were you able to examine either or both parts of the catheter? You might be able to get more information from that.
In my reviews of risk management issues related to vascular access, I find that insertion and removal of catheters and documentation of the catheter tip is often dismissed, or not considered. Nurses and other providers can still be VERY cavalier about these "simple little devices" - that can cause significant morbidity, and mortality.
When our facility was building the electronic health record, I pointed out that there was no way to document that a catheter tip was in tact upon removal, and the response I got was "No one ever does that!". There IS now a way to document this.
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Ann Zonderman, BSN, JD, CRNI, LHRM
So, was the catheter tip retrieved??? What did it look like?? This could be a key issue if ever a law suit resulted.
Manufacturers do dilligent quality control to ensure integrity of the devices to prevent inadvertent separaton but make material radio opaque (for locating device via x-ray) just incase a problems arises.
If a product failure is suspected, it is a good idea to save all the product, report it to the manufacturer and also to the FDA web site - MAUDE ... this process allows notice/ tracking of problems/ recalls . Alerts we all need to watch for.
Ann Zonderman, BSN, JD, CRNI