CASE XIII:
EVALUATION
OF PERMANENT INJURY FROM AN INFILTRATED INTRAVENOUS
CATHETER
SUMMARY:
On
8/13/96, the examinee was noted to be a 33 year old male with an extensive
gastrointestinal history of alcoholism. On
5/95, he apparently was diagnosed with a large pseudocyst
and pancreatitis, and during 6/95, because of the large pseudocyst, a
Roux-en-Y cystojejunostomy and jejunostomy was performed from which the examinee
had improvement. During 3/96,
the examinee was noted to have obstructive jaundice and had an ERCP, which
demonstrated portal hypertensive gastropathy with distal common bile duct
obstruction secondary to ongoing pancreatitis and a stricture of the distal 3rd
common bile duct which was dilated; a stent was placed, and the examinee was
followed by local physician, Dr. The
examinee also had diabetes at the time of pancreatic pseudocyst drainage and was
on 15 units of NPH insulin.
On 12/20/96, M.D.
diagnosed the examinee with obstructive jaundice secondary to distal common bile
duct stricture in a setting of chronic pancreatitis.
On 4/29/97, M.D. diagnosed the examinee with
residual edematous fold second portion of the duodenum surrounding the ampullary
structure and obliterating normal landmarks, removal of biliary endoprosthesis,
retrograde cholangiography documented resolution of distal common bile duct
stricture after performing an endoscopic retrograde cholangiography with removal
of biliary endoprosthesis.
On 5/8/97, M.D. diagnosed
the examinee with recurrent cholecystosis
post stent placement secondary to compression of distal bile duct and setting of
the chronic pancreatiti after perfrorming an endoscopic retrograde
cholangiography placement of biliary endoprosthesis.
On 11/19/98, M.D.
diagnosed the examinee with compression of
the proximal second portion of the duodenum by chronic pancreatitis, indwelling
biliary endoprosthesis with ulceration of the contralateral and duodenal wall,
removal of biliary stent, cholangiography documenting residual common duct
obstruction, replacement of biliary endoprosthesis of 11 French, 7.5 cm. After
again performing an endoscopic retrograde cholangiography with replacement of
indwelling biliary endoprosthesis.
On 6/23/99, the examinee
was discharged from Hospital by D.O.after having been evaluated and treated
status post exploratory laparotomy with dissection of port hepatic,
cholecystectomy with operative cholangiogram and a wedge biopsy of the liver,
biliary obstruction, status post endoscopic stent replacement, chronic
pancreatitis with splenic venous thrombosis, status post endovascular stent
within the portal vein, status post Roux-en-Y cystojejunostomy, ileus and
obstructive jaundice secondary to chronic pancreatitis, routine stent exchange.
6/9/99, M.D. noted preoperative clearance had been requested by Jeffrey L.
Steers splenectomy and hepatojejunostomy with stent removals the examinee had
failed an 18-month trial of stent exchanges and endoscopic biliary stent
replacements.
On 6/11/99, M.D., surgeons, diagnosed the examinee with biliary
obstruction status post endoscopic stent placemen, chronic pancreatitis with
splenic vein thrombosis, status post endovascular stent within the portal vein
and status post Roux-en-Y cystojejunostomy.
On 6/13/99, 9:15, a Nursing note indicates the
examinee complained of left hand numbness distal to 18 gauge site, D/Ced;
generalized edema was noted systemically and a positive CMS with hand.
The examinee was unable to completely lift left great finger and had pain
relieved by morphine sulfate.
On 6/14/99,
Department of Rehabilitative Services, Hospital also noted swelling of the
left hand 2nd and 3rd digits (presumably) from the IV.
The hand had a decreased left grip secondary to numbness.
On 6/15/99, hepatologist,
noted numbness of the left
fingers secondary to an infiltrated
IV.
On 10/8/99, M.D. noted
the examinee was feeling well with the exception of left hand weakness with
numbness in distribution of radial nerve present, which had not improved since
the recent surgical procedure presumably due to arterial line placement.
The examinee was referred to physical medicine for hand
difficulties.
On 11/16/00, M.D. noted the examinee was completely asymptomatic from GI
standpoint and that his only concern was left arm and hand weakness, which
the examinee attributed to his surgical procedure about one year ago.
On 3/01/01, M.D.
reevaluated the examinee for chronic pancreatitis, biliary stricture and an
episode of cholangitis for which the examinee took Cipro with prompt resolution
of symptoms. … The examinee was noted to have lost 10 pounds, was recently
separated from his wife and under considerable stress in addition to having
diabetes and situational depression for which Prozac was recommended.
No mention was made in the medical record of left arm or hand weakness
and/or numbness.
CONCLUSION:
1.
Within a reasonable
degree of medical probability, an infiltrated IV of the left arm caused the
examinee’s symptoms of numbness and weakness noted first post-operatively on
6/13/99
and last on
3/01/01
at
the medical evaluation by M.D.
2.
As of 01/02 no
additional medical records are available for review with regard to the
examinee’s history of numbness and weakness in the left arm and hand.
]
Within a reasonable degree of medical
probability, the examinee may have developed a permanent injury from the
infiltrated intravenous needle and solution, however additional objective
documentation, such as medical records within the last year from a physician who
had clinically and/or electrophysiologically evaluated the motor and sensory
function of the left arm and hand, would be required.
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