Patient is Injured by Contrast Fluid

This case takes place in Indiana and involves a patient with a past medical history of intravenous drug abuse. The patient was due to undergo a radiology procedure, and the patient’s PCP requested that a PICC line -as opposed to a standard catheter – be used to inject the contrast fluid. Instead of using a PICC line, as was ordered by the patient’s PCP, the radiologist elected to use a standard catheter. Because of the patient’s long history of drug abuse, the catheter ruptured the vein in which it was placed, and as a result a significant amount of contrast material entered the patient’s body. The patient suffered compartment syndrome and carpal tunnel syndrome, requiring additional treatments and causing permanent injury.

Question(s) For Expert Witness

Expert Witness Response E-007952

I have extensive experience inserting PICC lines. I am unclear about which “radiology procedure” the patient was to undergo. I assume it was a contrast-enhanced CT scan. Based on this assumption, in most “uncomplicated” patients, a PICC line is not necessary for contrast administration. A standard angiocatheter can be used most of the time. However, a patient with a past medical history of IV drug abuse represents a “complicated” patient. Repeated peripheral access with infusion of non-medical substances can cause peripheral venous stenoses and occlusions. In that instance, it is neither unreasonable nor uncommon to request a PICC or other type of central venous catheter for contrast administration. So, if my assumptions are correct given the provided history, a PICC (or other central venous catheter) was indeed indicated.

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