When Cannula Positioning Leads to Permanent Harm: A Case of Iron Extravasation Injury

Failing to stop an iron infusion when symptoms emerge is not just risky, it’s indefensible

An otherwise routine iron infusion escalated into a long-term injury when a patient experienced rapid swelling and discomfort shortly after cannulation. Rather than recognising the signs of iron extravasation injury and ceasing the infusion, the procedure continued resulting in a lasting skin stain known as an “iron tattoo”. In this case, a nursing expert concluded that the administration of Ferinject failed to meet the standards of safe practice, particularly in relation to how early warning signs were handled.

Despite the presence of clear red flags; swelling, discomfort, and eventual tissue staining the cannula was not removed, the infusion was not resited, and the aftercare documentation was found to be lacking. The nursing response failed to mitigate the outcome, and there was no record of the recommended VIP (Visual Infusion Phlebitis) scoring being completed.

Multiple breaches in managing an iron extravasation injury

The expert's review pinpointed several critical errors contributing to the avoidable injury:

1. Cannula placement: Evidence suggests the cannula was either incorrectly sited or became displaced early during infusion.

2. Failure to act on symptoms: Swelling and discomfort are hallmark symptoms of iron extravasation, yet the infusion continued without intervention.

3. Lack of documentation: There was no VIP score or cannula assessment recorded—making the clinical decisions difficult to defend.

4. Poor aftercare protocol: No cold compress was applied, no referral to plastics was made, and no clinical photography was taken.

5. Misleading reassurance: The patient was advised the discolouration would fade, despite expert knowledge that iron stains are typically permanent.

   
   

“When iron leaks into tissues, the damage is usually irreversible. That’s why it must be treated as a high-risk infusion from the start.”— Apex Nurse Expert Witness

This iron extravasation injury could and should have been prevented

If nursing staff had ceased the infusion when the patient first reported swelling and discomfort, it’s likely the skin staining could have been avoided or at least minimised. Further failures in post-infusion observation, escalation, and treatment compounded the problem.

The expert concluded that the breach in duty was clear. The failure to stop the infusion, recognise signs of injury, and act according to standard protocols made the case clinically indefensible.

Need an expert witness to comment on an iron extravasation injury? Get in touch with us at info@apexexperts.co.uk, call us on 0203 633 2213 or visit our contact us page.