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Lisa B
Nerve damage from IV placement

I have been asked to pose this question to the group:

How commonly does nerve damage occur from improper IV site selection? Anecdotes/published research?

More generally, how often are bad outcomes associated with suboptimal IV site selection?


I have limited experience

I have limited experience with legal work acting as an expert witness. Over the past 11 years I have reviewed about 75 cases, however ~95% of those have been about infiltration and extravasation injuries. The major cause is improper site selection in an area of joint flexion, usually the hand or wrist without documentation of adequate stabilization or use of a handboard. These injuries have all lead to compartment syndrome requiring fasciotomy, complex regional pain syndrome (a chronic nerve pain condition), or necrotic ulcers requiring plastic surgery. I have even had several cases of amputation due to arterial injuries. If only the worst make it through the legal system, I would hesitate to guess how many patients are actually injured to a lesser degree. 

Here is a list of articles about nerve damage from peripheral venipuncture:

1.    Zubairy A. How safe is blood sampling? Anterior interosseus nerve injury by venepuncture. Postgraduate Medicine. 2002;78:625.
2.    Yuan R, Cohen M. Lateral antebrachial cutaneous nerve injury as a complication of phlebotomy. Plastic and Reconstructive Surgery. 1984;76(2):299-3000.
3.    Edwards W, Fleming L. Radial nerve plasy at the elbow following venipuncture: Case report. The Journal of Hand Surgery. 1981;6(5):468-469.
4.    Ragoowansi R, Kirkpatrick N, Moss A. Posterior interosseous nerve palsy after intravenous cannulation of forearm. Journal of the Royal Society of Medicine. 1999;92:411.

This article documents that more than 50% of major and minor complications occur from IV sites in the hand or wrist area:

1.    Kagel E, Rayan G. Intravenous catheter complications in the hand and forearm. Journal of Trauma. 2004;56:123-127.

When I review a case, site selection, cannula selection, stabilization, use of handboards, and medication administration techniques are usually the most frequent problems that I see. Lynn 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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