Out of Court Settlement following Cannula Fracture Injury at Mid Cheshire Hospitals NHS Foundation Trust.

An out of court settlement has been awarded to a young woman who suffered avoidable pain and the need for surgery to remove a fractured IV cannula from her arm, after it was left in place too long.

Adam Wright, a specialist Clinical Negligence Solicitor at Setfords Solicitors was instructed to represent a young woman who suffered avoidable pain and the need for surgery after an IV cannula was left in place too long. The cannula, which had been placed several days earlier to administer pain relief, broke during a fall, leaving behind a fragment which required surgical removal.

The Claimant, who wishes to remain anonymous, attended Accident and Emergency at Mid Cheshire Hospitals NHS Foundation Trust complaining of abdominal pain. It was suspected that she might have a ruptured ovarian cyst. A cannula was sited to her right wrist to administer pain relief and she was referred to the Gynaecologists.

She was admitted for observations and the cannula was used to administer IV (intravenous) paracetamol during this time.

On the third day of her admission, it was noted that her condition was improving and so her prescription for IV paracetamol was switched to oral paracetamol. This meant that the cannula was no longer being used, however, it was not removed.

The following day, her paracetamol prescription was stopped altogether, still, the cannula was not removed.

Later that evening, whilst visiting the bathroom, the Claimant fell, knocking the cannula during the fall which caused it to break. A fragment from the cannula remained in her wrist whilst the external body of the cannula fell away.

She reported the incident to the nursing team, who sought advice from the vascular surgeons. The vascular surgeons arranged to examine her. They identified mild swelling to the wrist and noted that the Claimant was complaining of pain. An x-ray identified that a 4.5cm fragment remained in her wrist.

The Claimant was listed for surgery to remove the fragment, however, the decision was later made not to operate on the basis that surgical intervention could damage the tendons and nerves within the area. The Claimant was informed that there was no risk of fragment migration and she was discharged.

In the weeks that followed, the Claimant continued to experience pain, numbness and pins and needles in her right arm, wrist and hand. Her symptoms prevented her from working as a Shop Assistant and she sought advice from her GP on a number of occasions.

The Claimant’s GP referred her to the vascular surgeons at the Royal Stoke University Hospital for a second opinion. A plan was made to have the fractured piece of cannula surgically removed a few days later.

The Claimant re-attended for her procedure and in incision was made in the right wrist at the location of the fragment, as identified by the previous x-ray. However, the fragment from the cannula could not be found. An ultrasound scan was then conducted which found that the fractured cannula had migrated up the Claimant’s arm and was now located in her forearm. A further incision was made and the fragment was successfully removed.

The Claimant continued to suffer from pain and swelling for a short time thereafter, but was left with two permanent scars to her right arm; one to her wrist and one along her forearm.

The Claimant contacted Adam Wright, a Clinical Negligence Solicitor at Setfords Solicitors, to investigate her concerns for the treatment she had received. She believed the incident to have been totally avoidable if the cannula had been removed at the time her IV Paracetamol prescription was stopped.

After obtaining the medical records, an expert Vascular Surgeon was instructed to prepare a report commenting upon the standard of care afforded to her.

The expert produced a report stating that any cannula over 72 hours hold must be observed with vigilance, properly observed and removed at the earliest opportunity to avoid complications such as infection and phlebitis. He opined that, when the cannula was no longer being used, because the prescription was switched to oral pain relief, there was a negligent failure in care not to have removed the cannula expeditiously.

He further opined that, had the cannula been removed it would not have been in-situ at the time of her fall the following day, thus avoiding the fracture and the events which followed.

Following receipt of the expert’s evidence, formal allegations of breach of duty and causation were submitted to the Trust. Their lawyers, NHS Resolution, investigated the allegations and provided a formal response admitting that the Trust breached its duty of care by failing to remove the cannula in a timely fashion. It was further admitted that had the cannula been removed prior to her fall, the fracture and retained fragment would not have occurred and she would not have developed pain in her wrist.

The Trust also issued a formal apology to the Claimant for the substandard care she received.

Settlement negotiations followed and an acceptable damages award was quickly agreed. Thankfully, the Claimant made a full recovery from her symptoms, although she is left with permanent avoidable scarring to her arm.