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nerve damage due to IV
I recently was in the hospital and had an IV and while they had to try a few times, one of these time it hit a nerve. The IV ended up in the other arm but a day or so after I got out of the hospital I started to have somwhat sharp pain in my wrist and down into the meaty part of my thumb.
I'm wondering if this will go away eventually or should I see someone about it?
I'm wondering if this will go away eventually or should I see someone about it?
I have been a nurse for over 20 years. I have probably started thousands of IV's. I have never seen anyone with permanent nerve damage from an IV. I have seen nerve injuries from arterial lines though.
Permanent damage can result when a needle point makes contact with a nerve.
“Nurse, I feel an electric shock going down my arm.” Would this patient complaint mean anything to you when you insert an IV catheter or draw blood? This feeling of shock is a classic symptom when a needle point makes contact with a nerve. It could result in permanent nerve injury — and malpractice litigation involving the nurse performing the procedure is not uncommon.
The two nerves most often injured during a venipuncture procedure are the radial and median nerves. The radial nerve passes along the thumb side of the arm, from the shoulder down into the wrist area, and is in close proximity to the cephalic vein. In a venipuncture procedure, the cephalic vein is often the vein of choice for many clinicians. The distal three inches of the radial nerve, just above the thumb, is the area most often injured during the insertion of peripheral IV devices.
The median nerve is the largest nerve in the arm. It runs inside the antecubital fossa and passes through the forearm into the palm of the hand. When nurses are drawing blood from the antecubital fossa or inserting peripheral IV devices, they could contact and injure this nerve. Insertion of IV catheters into the superficial veins of the inner aspect of the wrist above the palm of the hand can result in serious injury to the median nerve and carpal tunnel syndrome.
If a patient complains of an electric shock-type sensation radiating down into his or her hand as the needle is being inserted, the appropriate intervention is to remove the needle immediately. The outcome will be minimal nerve damage without permanent injury; however, if the nurse continues to advance the needle farther into the nerve, a permanent, progressive, and painful disability resulting in reflex sympathetic dystrophy (RSD) or complex regional pain syndrome (CRPS) can result. Patient symptoms can include a mottled and cold hand and forearm, hypersensitivity to temperature changes, excessive nail and hair growth, and the inability to lift heavy objects. CRPS is diagnosed by patient history and nerve conduction studies. Treatment options include long-term pain control with narcotics, multiple nerve blocks, and even implanted morphine pumps, as well as splints, casts, and TENS (transcutaneous electrical nerve stimulation) units.
Best practice mandates nurses avoid areas of high-risk nerve injury by using landmarking techniques. The three-inch area above the thumb and the three-inch area on the inner aspect of the wrist should always be avoided since the radial and median nerves can be superficial in these areas. The risk of permanent nerve injury outweighs the benefit of IV insertion in these areas.
Standards of Practice
The Infusion Nursing Standards of Practice can be used in court to determine whether a nurse delivered appropriate infusion care to a patient. The standards state “site selection should avoid areas of joint flexion.”1 The wrist and antecubital fossa are areas of joint flexion. Insertion of peripheral IV catheters into these areas for delivery of infusion therapies can be determined to be deviations from the standard of practice. These deviations, with documented injury to the patient, can be contributing factors in a malpractice verdict against a nurse. When necessary, the physician should be notified that an alternative vascular access device will be required to safely administer the IV medications.
Nerve compression injuries are also related to infusion therapy. These occur when a patient sustains an infiltration of a large amount of IV solution into the tissues. The IV fluid in the tissue increases the pressure within the tissues, resulting in compartment syndrome; and the duration of the high tissue pressure determines the amount of permanent nerve damage. Nerve compression is indicated when a patient’s arm is infiltrated and he or she complains of numbness and tingling within the swollen area. The appropriate nursing intervention is to stop the infusion and notify the physician immediately. An emergent fasciotomy, which consists of two surgical incisions along the entire length of the arm, is required to relieve the increased tissue pressure. The incisions are left open; and, in some cases, penrose drains are used to aid in fluid drainage. A second surgical procedure is required to close the wound, and the patient will have extensive scarring of the forearm and hand.
Permanent nerve injuries are preventable by avoiding high-risk superficial nerve areas for venipuncture and by frequently documenting IV site assessments. Nerve injury related to venipuncture is one of the most common areas of nursing malpractice in which the nurse is identified as the primary defendant. Remember — listen to the patient. Remove the IV device immediately if the patient has symptoms of nerve contact during venipuncture, and avoid high-risk nerve injury areas.
“Nurse, I feel an electric shock going down my arm.” Would this patient complaint mean anything to you when you insert an IV catheter or draw blood? This feeling of shock is a classic symptom when a needle point makes contact with a nerve. It could result in permanent nerve injury — and malpractice litigation involving the nurse performing the procedure is not uncommon.
The two nerves most often injured during a venipuncture procedure are the radial and median nerves. The radial nerve passes along the thumb side of the arm, from the shoulder down into the wrist area, and is in close proximity to the cephalic vein. In a venipuncture procedure, the cephalic vein is often the vein of choice for many clinicians. The distal three inches of the radial nerve, just above the thumb, is the area most often injured during the insertion of peripheral IV devices.
The median nerve is the largest nerve in the arm. It runs inside the antecubital fossa and passes through the forearm into the palm of the hand. When nurses are drawing blood from the antecubital fossa or inserting peripheral IV devices, they could contact and injure this nerve. Insertion of IV catheters into the superficial veins of the inner aspect of the wrist above the palm of the hand can result in serious injury to the median nerve and carpal tunnel syndrome.
If a patient complains of an electric shock-type sensation radiating down into his or her hand as the needle is being inserted, the appropriate intervention is to remove the needle immediately. The outcome will be minimal nerve damage without permanent injury; however, if the nurse continues to advance the needle farther into the nerve, a permanent, progressive, and painful disability resulting in reflex sympathetic dystrophy (RSD) or complex regional pain syndrome (CRPS) can result. Patient symptoms can include a mottled and cold hand and forearm, hypersensitivity to temperature changes, excessive nail and hair growth, and the inability to lift heavy objects. CRPS is diagnosed by patient history and nerve conduction studies. Treatment options include long-term pain control with narcotics, multiple nerve blocks, and even implanted morphine pumps, as well as splints, casts, and TENS (transcutaneous electrical nerve stimulation) units.
Best practice mandates nurses avoid areas of high-risk nerve injury by using landmarking techniques. The three-inch area above the thumb and the three-inch area on the inner aspect of the wrist should always be avoided since the radial and median nerves can be superficial in these areas. The risk of permanent nerve injury outweighs the benefit of IV insertion in these areas.
Standards of Practice
The Infusion Nursing Standards of Practice can be used in court to determine whether a nurse delivered appropriate infusion care to a patient. The standards state “site selection should avoid areas of joint flexion.”1 The wrist and antecubital fossa are areas of joint flexion. Insertion of peripheral IV catheters into these areas for delivery of infusion therapies can be determined to be deviations from the standard of practice. These deviations, with documented injury to the patient, can be contributing factors in a malpractice verdict against a nurse. When necessary, the physician should be notified that an alternative vascular access device will be required to safely administer the IV medications.
Nerve compression injuries are also related to infusion therapy. These occur when a patient sustains an infiltration of a large amount of IV solution into the tissues. The IV fluid in the tissue increases the pressure within the tissues, resulting in compartment syndrome; and the duration of the high tissue pressure determines the amount of permanent nerve damage. Nerve compression is indicated when a patient’s arm is infiltrated and he or she complains of numbness and tingling within the swollen area. The appropriate nursing intervention is to stop the infusion and notify the physician immediately. An emergent fasciotomy, which consists of two surgical incisions along the entire length of the arm, is required to relieve the increased tissue pressure. The incisions are left open; and, in some cases, penrose drains are used to aid in fluid drainage. A second surgical procedure is required to close the wound, and the patient will have extensive scarring of the forearm and hand.
Permanent nerve injuries are preventable by avoiding high-risk superficial nerve areas for venipuncture and by frequently documenting IV site assessments. Nerve injury related to venipuncture is one of the most common areas of nursing malpractice in which the nurse is identified as the primary defendant. Remember — listen to the patient. Remove the IV device immediately if the patient has symptoms of nerve contact during venipuncture, and avoid high-risk nerve injury areas.
I'm very aware of what you are saying. My point is....I have never seen this happen. It is extremely rare.
3 Comments
But you probably wouldn't know how often it does, because patients this happens to often don't realize they actually suffered any damage until the next day, and you may not know they sought urgent care for it afterward or went to their doc. Not all will notify the ER or facility where they suffered a painful IV or blood draw.
But you probably wouldn't know how often it does, because patients this happens to often don't realize they actually suffered any damage until the next day, and you may not know they sought urgent care for it afterward or went to their doc. Not all will notify the ER or facility where they suffered a painful IV or blood draw.
I have to say this sucks. I am dealing with it right now I complained the second it was put in about the pain and was ignored and brushed off. literally told "it is in your hand it will hurt" by the man putting it in and the 2 nurses afterwards. I felt the pain through the drugs I had in the hospital! I currently after a full 5 weeks have very limited right hand movement which sucks as I am a righty and very unusual because I am hyperflexiable. My right hand gets cold very easily and is still swollen. the intense shooting pain is not longer there, gone after a week or so but the dull achey stiffing pain has not subsided and it radiating down my arm and up my fingers and causing them to swell as well. I am not sure how rare this actually is but my doctor is worried and so am I! Trying to do everything with my left hand sucks. typing sucks, usuing my mouse sucks and driving I can not even grip the wheel. I can barely make a fist because the swelling is getting so bad. i hope noone has to go through this. it was my only surgery ever and go figure an IV in the hand causes me more pain than they recovery of the surgery.
What was the outcome? It is two months later.
I just had this happen to me last week. Any feedback as to length of your condition would be interesting. thanks
I just had this happen to me last week. Any feedback as to length of your condition would be interesting. thanks
I too was recently in the hospital. Male nurse put in a BIG IV (I was dehydrated & needed fluids). The insertion REALLY hurt. More than it should have. I've had IVs in the past, but the pain of putting one in didn't compare to other times. I was in the hospital 3 days. On the 3rd day, the IV started to bleed, but I was finally released. Now, a month later, I still have difficulty turning my wrist and lifting things with my hand in certain positions. It gets worse when I use my wrist/hand more. Do I have ANY recourse? The hospital I was in gave very shoddy treatment..... ~lisa
I had surgery on Feb 6th, with the IV on My right wrist. My thumb and fingers whent numb right away but I did not know any better so I did not say anything. The IV was in for 3 days and my thumb and forefiinger are still numb to this day. As I use my hand to work on the computer I find that I get shooting pains throughout the hand that be the end of the day are shooting up to my forearm. The viegn is swollen and I am not sure what to do. My orthepedic surgion says to just wait and when I tried to get to a neaurologist he said he could do no more that whe my surgeion was doing. I am getting scared as this is effecting my work out put.
Thanks Karen
Thanks Karen
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