Cannula Insertion Complications: When Documentation Falls Short but Care Doesn’t

A nurse expert’s take on cannula insertion, record-keeping, and risk

In fast-paced acute hospital environments, peripheral cannula insertion is a daily procedure often performed under immense pressure. But even routine interventions like these can result in complications, particularly when post-discharge outcomes involve pain, infection, or thrombus.

In a recent medico-legal case, a patient developed a cephalic vein thrombosis shortly after discharge from hospital, prompting a clinical negligence claim. The key allegation? That the cannula had been negligently inserted into the antecubital fossa (ACF) and that the choice of site lacked justification.

Yet, as this report demonstrates, cannula insertion complications do not automatically equate to clinical failings especially when the rationale reflects common and widely accepted practice.

The expert nurse, applying the Bolam and Bolitho tests, concluded there was no breach of duty in the choice of cannulation site. The ACF is frequently used, especially when patients require short-term IV access. Critically, the patient was monitored, managed appropriately when symptoms emerged, and recovered well after timely intervention.

Cannula insertion complications must be evaluated against real-world practice

A number of claims centred around documentation namely, that the records failed to justify the site selection and lacked clear follow-up advice. The expert agreed that the documentation could have been more comprehensive but found that this did not contribute to any injury.

Key observations included:

• The ACF is a clinically acceptable site for short-term cannulation

• There is no general expectation to document the rationale for choosing one vein over another

• Nurses provided oral advice and antibiotics at discharge

• The patient accessed community care within 24 hours and was promptly treated

• There was evidence the cannula was monitored daily and noted as healthy (VIP 0)

While record-keeping was incomplete, cannula insertion complications must be distinguished from avoidable harm. The report emphasised that a lack of pristine notes isn’t automatically negligent, especially when the patient accessed care and received appropriate treatment in good time.

“A tube into the body can always cause irritation or infection. That doesn’t mean it was wrongly placed. The key is how the patient was monitored and how quickly support was accessed when a concern arose.”— Apex Nurse Expert Witness

When poor records don’t mean poor care

In many claims, gaps in records are interpreted as failures. But healthcare delivery, particularly during unscheduled admissions, is rarely perfectly documented. The expert highlighted that documentation around the cannula could and should have been better but that the intervention was timely, safe, and effective.

This case underscores a vital medico-legal truth: documentation gaps must be distinguished from breaches of duty. If the care provided meets accepted standards and is supported by clinical logic, even imperfect records may not amount to negligence.