I would like to share a situation and ask for feedback: A pt has new diagnosis of bilateral upper extremity ischemia. Presents with necrosis and redness of fingertips to left hand (good radial pulse),also has left arm dialysis fistula. Within a day or two develops discoloration to right fingers with patchy redness to right lower arm (also good radial pulse,ultrasounds neg for dvt in both arms). To make a long story short,our team was asked to put in a picc. We declined on the basis of compromised blood flow already to arms (based on symptoms) without a yet known cause of ischemia. The vascular surgeon told us that since the suspected cause was arterial we should not be concerned about a picc causing any compromise. She did not want to place an IJ or subclavian because of the "larger caliber of the catheter" compared to a picc incase of any central occlusion. Our manager assured us that our team would not be liable for any complications caused by a picc because the vascular surgeon was "the expert and we followed her instructions". We also had reservations about this statement. My question is were we right not to place a picc before a cause of the ischemia was found? We placed a peripheral with ultrasound( limited venous access options) for a CT angio as that was the primary need at that time. Thanks for your input.
I know you were right and that your manager is way off base with that statement. In a lawsuit, everyone is named. The frequent exception is when physicians are not even included in the lawsuit. I have never seen a situation in more than 300 cases reviewed where the physician stepped up and said I am the one who ordered it and I have all of the accountability. It simply does not work that way in a court of law. It does not matter what the written order, who says what about the situation, it all comes down to the judgment and actions of the person(s) who performed the activity. It is your decisions before, during, and after insertion that will be scrutinized in a legal case. A PICC could have been used for an IJ insertion if your team has that skill. Perhaps this is an ideal situation to justify expansion of your practice to include that service also. Lynn
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
Thank you. that is a great suggestion. I will take it to our team and see what they think. Thanks again