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  • Overview

    James Cahan, specialist clinical negligence lawyer based at Thomson Snell & Passmore’s Tunbridge Wells and Dartford (Thames Gateway) offices, has secured £20,000 for a child who suffered necrosis of the tissue on the back his hand, requiring plastic surgery, after an extravasation injury.

    The claimant in this clinical negligence claim was a 5 month old baby who attended the accident and emergency department at the University Hospital, Southampton after suffering an episode of vomiting and diarrhoea. A&E staff felt that he was suffering from dehydration and that he should be started on intravenous fluids via a cannula.

    The A&E staff attempted to cannulate the claimant’s right hand without success. He was then sent on to the Paediatric Assessment Unit where a gauge 24 IV cannula was inserted into his left hand. The claimant was then transferred to paediatric medical unit (PMU).

    Sometime later it was suggested by a nurse that a sock should be put over the cannula site. It was also noted at that time that the infusion pump alarm kept going off and therefore the alarm was switched off.

    The cannula was only checked on two occasions throughout the night before the night nurse went on a break at 04:40am but forgot to ask another member of staff to undertake the visual infusion phlebitis (VIP) score test, to monitor the infusion site.

    The claimant’s mother woke at around 6am to the claimant crying. She picked him up to feed him and noticed that the sock covering the cannula was wet. She immediately rushed out to find a nurse.

    The cannula had become dislodged from the vein, causing the IV fluids to leak into the surrounding tissue in the hand. The failure to monitor the cannula site and to reinstate the infusion alarm meant this had gone undetected causing the hand and arm to become grossly swollen.

    The registrar was called and advised that the hand should be raised but no flushing procedure was instigated.

    Within three days two blisters had begun to form on the claimant’s hand. He was discharged the day after. On his second day at home a community nurse found that there was a black area on the back of the hand.

    Over the next two weeks the district nurse reported her concerns over the treatment plan for the claimant’s hand. By the time the claimant was reviewed by a dermatologist, 20 days after his discharge, there was an offensive odour from the wound and a full thickness necrosis was recorded (death of the tissue within the hand).

    An urgent referral was made to the plastic surgeons and the claimant was seen at Salisbury Hospital. The claimant underwent debridement surgery to remove the dead tissue and required a full thickness skin graft. Thankfully the skin graft was successful.

    James Cahan, acting for the claimant, obtained a report from a Hand and Plastic Surgeon who stated that there was a risk that the claimant would require further surgical intervention at around the age of 4 or in adolescent to release tightening in the hand. Otherwise it was felt that the claimant would make a full recovery with no restrictions to his physical abilities.

    James was able to negotiate an out-of-court settlement of £20,000 to compensate the claimant for his pain and suffering and to make provision for any future surgeries he may require.

    James Cahan specialises in child clinical negligence cases. If you would like to ask James a question about a potential case, or if you have a general query about any clinical negligence, contact James on 01892 701289 in confidence.

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