How physicians and other health care practitioners can reduce the financial costs of IV injury

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Up to 50% of intravenous lines (IVs) fail, often with severe consequences, including medication dosing errors, scarring, skin staining, nerve damage, amputation, and even death.

This creates immense exposure for any physician or medical staff involved in IV care. All providers who are involved in patient care are responsible for monitoring IVs. Whether you place the order for an infusion, place the IV catheter itself, or assess the patient, you are part of the care team that is monitoring that IV, ensuring that it is adequately giving the medications needed and maintaining a high level of patient safety, preventing injuries associated with infiltrations and extravasation.
In fact, medical malpractice attorneys are making IV infiltration and extravasation – common conditions that arise from IV fluid leaking outside the vein – a lucrative area of practice, as evidenced by these recently reported lawsuits:

• Late last year, a jury in Cumberland County, New Jersey, awarded $500,000 to a woman who suffered chemotherapy extravasation during treatment for breast cancer.
• In 2022, a Wisconsin jury awarding $11 million to a man who suffered an amputation due to failure to monitor an IV properly.

This can be incredibly concerning to those practicing in multiple health care settings. IV insertion, care, and monitoring happen in a number of settings: inpatient, outpatient, infusion centers, primary care. This care is constantly evolving and health care workers who might not have consistent, up-to-date training are being asked to place and maintain these lines on a more common basis.

Gary Warren, MS
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In the United Kingdom, where the National Health Service (NHS) is addressing extravasation injuries region-wide via a formal resolution designed to raise awareness of the need for close IV monitoring, the organization estimates that these injuries have cost the NHS over £15.6 million.

So, what role should health care executives play in protecting their patients from harm and their organizations from expensive litigation and potentially catastrophic financial consequences? As with many things, the first step towards addressing the problem is admitting one exists. For too long, hospitals and other health care organizations have swept this issue under the rug, crossing their fingers and hoping their organization and employees will not be unlucky enough to have their patients experience this type of injury.

This head-in-the-sand approach is destined to fail, and we have seen this time and time again. I received a call recently from an emergency doctor in the Midwest who said, “I had a 21-year-old patient last week with severe diabetic ketoacidosis whose brain death might have been prevented [by effective monitoring]. I’m on a mission now.”

Russ Nassof, JD, is an attorney and health care risk consultant based in Henderson, Nevada. He notes that IV failure is a silent epidemic with wide-ranging and potentially severe repercussions for hospitals and hospital systems.

He notes: “Clinical standards dictate that patient IVs are monitored in order to quickly detect infiltration or extravasation, with closer scrutiny required depending on the infusion. For instance, strong vesicants used in oncology departments carry a much higher risk of IV injury given the caustic nature of the drugs being delivered.”

A perfect storm

The current state of health care in the United States lends itself to an increased likelihood of IV injury and greater liability exposure levels. Pre-COVID, the nursing shortage was already affecting clinical staff’s ability to monitor IVs for injury carefully, but the ensuing increase in staffing shortfalls has exacerbated this issue. Add that to the “seniority gap” currently experienced in the U.S. as seasoned nursing professionals retire and less experienced nurses take their place.

Nasoff notes that liability issues occur when IV injuries are not promptly identified and properly treated, a scenario compounded by inexperienced nursing staff. Of particular concern are those patient populations who are most vulnerable when extravasation or infiltration occurs, specifically geriatric patients and children, especially those in neonatal intensive care units (NICUs).

With the former, patients 65 and older experience the highest hospitalization rate of any age group, which automatically puts them at greater risk of IV injury. Couple that with the fact that their vasculature is more prone to breaking down than in younger patients and that they are more likely to receive antibiotics and other meds via IV vs. a central line, and you have your largest patient segment facing a higher risk to their health, and you and your organization facing a higher risk of liability and malpractice exposure.

With the latter group, neonates in particular are at high risk for unpredictable and unpreventable IV-therapy-related complications due to their immature immune systems, fragile skin and blood vessels, and their exposure to additional invasive procedures. Add to this their inability to communicate pain and discomfort, and the ramifications are frightening.

Facing up to the risk

In addition to hospitals, physicians and nurses are increasingly named in extravasation lawsuits. Nasoff notes: “The issue with these claims is that they have a very high probability of being resolved in the patient’s favor because the tendency to sweep IV injury under the rug leaves organizations vulnerable if they have no documentation that they were indeed monitoring the IV and, if they were, why this type of injury has even occurred. That’s why these claims are almost always settled.”

So, how do you protect your staff and your organization? It’s critically important to follow clinical standards that are important to prevention. Our organization recently joined the National Patient Safety Board (NPSB) Advocacy Coalition, which seeks to address the overarching patient safety crisis in the United States, where more than 250,000 patients die annually from preventable medical harm at a cost of $17 billion to the U.S. health care system.

An NPSB would ensure that recommendations and solutions are created to augment current clinical standards and prevent future harm while also leveraging existing systems to bring key learnings into practice. This would guarantee a data-driven, scalable approach to preventing and reducing patient safety events in health care settings.

And Nasoff notes that some pioneering organizations are turning to emerging technology that can monitor constantly for infiltration and extravasation. But ultimately, it falls to each and every health care executive to acknowledge the physiological risk that this most common of hospital procedures presents to the patients they are treating, but also the risk it carries for their organizations’ medical staff – and to their bottom lines.

Gary P. Warren, MS, is president, CEO and board member of ivWatch, where he is named as a co-inventor on 65 utility patents granted by 13 patent offices around the globe. In March 2024, business innovation tracker Fast Company named ivWatch to its list of the World’s Most Innovative Companices of 2024, and No. 6 on its list of the top 10 most innovative medical device companies.