Case Study: How a Peripheral Cannula Injury Expert Witness Reviewed Swelling and Missed Documentation in Post-Surgical IV Care

Why post-operative swelling isn’t always negligence but missing records make defence harder

This expert nursing review centres around the care of a patient admitted for revision of the temporomandibular joint. Post-operatively, she required IV fluids and pain relief through a patient-controlled analgesia (PCA) device. However, concerns later arose over a suspected peripheral cannula injury, following documented leg swelling and contradictory records about whether IV fluids were stopped in time.

An Apex peripheral cannula injury expert witness reviewed the case to assess if there were any breaches in duty. While the expert acknowledged that peripheral extravasation is a known clinical risk, he concluded that failings in documentation and the lack of clear VIP scores during key timeframes likely constituted a breach of standard nursing practice.

What the peripheral cannula injury expert witness identified in monitoring and documentation

The patient had complex medical needs and was difficult to cannulate. Two cannulas were in place, one in the foot and one in the hand. Despite the generally good standard of nursing observed throughout her admission, the expert highlighted several issues:

• VIP (Visual Infusion Phlebitis) scores were not recorded during the immediate post-operative period and night shift

• Fluid charts were either missing or incomplete, making it difficult to establish what was administered after swelling was noted

• A note recorded swelling of the left leg at 7am, but fluid was still described as "running" after that time

• The cannula was not removed until some time later during the day shift, without documentation of an exact time

• The patient’s complaint that removal was delayed couldn’t be substantiated, but poor record-keeping weakens the Trust’s defence

• Nurses were part of the ward round decision to remove the cannula but delayed action may have prolonged exposure to risk

“Cannula injuries happen, even with good care. But when documentation is incomplete and fluids possibly continue after swelling is seen, it becomes hard to defend.” — Apex Peripheral Cannula Injury Expert Witness

What a peripheral cannula injury expert witness expects in post-op monitoring

For post-surgical patients on IV fluids and PCA, expert nursing expectations include:

1. Consistent VIP scoring every shift, particularly following theatre

2. Full documentation of cannula site checks when complications such as swelling or pain are noted

3. Immediate cessation of IV infusions if swelling or extravasation is suspected

4. Timely removal of the cannula after a plan is made, with a documented time

5. Fluid charts that correspond to cannula site monitoring and drug administration records

In this case, while there were no signs that nurses ignored concerns, the lack of fluid charting and delayed documentation of cannula removal weakened the overall defence.

Known risks don’t eliminate responsibility, especially when signs are missed

Peripheral cannula complications, including infiltration and extravasation, are common risks in nursing. But documentation is the key safeguard, for patient safety and for legal protection. The expert concluded that if fluids continued after swelling was observed, this would constitute a clear breach of duty.

Although the long-term vascular impact would fall under a consultant’s opinion, the expert’s nursing perspective was clear: the monitoring and record-keeping in this case fell below acceptable standards.