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Maim, death cases following the installation of vascular access devices filed with specialized forensic medicine
Fares Najari1, Jalaluddin Khoshnevis1, Zahra Javaheri1
1Clinical Research Development Center of Shohada-ye-Tajrish Hospital, Vice- Chancellor in Research Affairs, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Complications from vascular access device implantation are increasing, leading to patient complaints and legal action. Careful patient selection and procedure execution are crucial to minimize risks and improve outcomes.
Area of Science:
- Medical Devices
- Patient Safety
- Forensic Medicine
Background:
- Vascular access device (VAD) implantation is critical for managing critically ill patients.
- Identifying complications is essential for improving patient care and safety.
- Forensic medicine commissions handle cases involving VAD implantation complications.
Purpose of the Study:
- To identify complications of VAD implantation leading to patient complaints.
- To analyze cases filed with Tehran's forensic medicine commissions (2013-2018).
- To understand the types and causes of VAD-related complaints.
Main Methods:
- Descriptive-cross sectional study of VAD implantation cases.
- Data collected from forensic medicine commissions in Tehran (2013-2018).
- Statistical analysis using chi-square and Fisher exact tests (p<0.01 significance).
Main Results:
- Deaths primarily linked to central venous port implantation; organ failure to anterior forearm deformity.
- Acute cardiac death was the most common cause of death; 14% experienced internal bleeding.
- Complaints varied by procedure: general surgery/anesthesia assistants for deaths, trainee nurses for venipuncture.
Conclusions:
- Patient awareness is rising, leading to increased VAD implantation complaints.
- Judicial involvement in VAD complications is growing.
- Careful patient selection and procedural diligence are vital for VAD implantation.
Background:
Implantation of vascular access devices is of great importance in critically ill patients or those vulnerable to clinical worsening. The aim of this study was to identify the complications of implantation of vascular access leading to complaints from patients, in the forensic medicine commissions of Tehran.
Methods:
The present descriptive-cross sectional study was performed on all cases that died from implantation of vascular access devices and complaints about permanent local complications caused by this procedure, filed with the forensic medicine commissions of Tehran in period of 2013-2018, based on selected variables, and the results were statistically analyzed using the chi-square and Fisher exact tests in SPSS Version 18. A p-value of <0.01 was considered statistically significant.
Results:
All alleged deaths were due to implantation of central venous port placed in a large vein in the neck, and most organ failure cases were attributed to anterior forearm deformity. The most common cause of death was acute cardiac death; internal bleeding was observed in 14% of them. Most complaints of death were filed against general surgery and anesthesia assistants, and most complaints about peripheral venipuncture were against trainee nurses. The present study findings were significantly different in terms of cannulation site, age, cause of death, type of local complication (p<0.01).
Conclusion:
This study shows, as patients become more aware, complaints from physicians about implantation of vascular access, in the judicial authority are also on the rise. Therefore, in choosing these patients, Venice should be treated more carefully.
