P. B. was born ten weeks premature and required supplemental oxygen and feeding via an umbilical venous catheter (UVC). Infants who are born premature often cannot be fed orally. They are fed nutritional fluid via a catheter which is placed through an umbilical vein. A UVC must be carefully placed. The tip of the catheter should be positioned just below the right atrium of the heart. Before placement is attempted, exterior measurements are made (such as from the shoulder to the navel) to determine the proper length for the internal positioning of the catheter. The UVC is then placed and a chest x-ray is performed to confirm proper positioning of the catheter tip. Right atrium placement of a catheter tip poses catastrophic risk. The heart of a premature newborn beats at a rate of approximately 140 beats per minute. When a catheter tip is placed within the newborn’s heart, repeated contact between the catheter tip and the heart wall will result in the tip burrowing through the heart wall such that the tip enters the pericardium (the cavity into which the heart beats). When nutritional fluid is directed into the erroneously placed UVC, the fluid empties into the pericardium (the cavity into which the heart beats). When the pericardium fills with fluid, the heart is no longer able to beat and blood flow comes to a stop. Cessation of blood flow results in damage to organs including the brain which require a continuous supply of oxygen rich blood.
An interning physician working under the supervision of a neonatologist miscalculated the measurement for the placement of the UVC that was placed in P. B. and as a result the catheter tip was positioned inside the right atrium of the child’s heart. The radiologist who reviewed the chest x-ray noted the faulty positioning of the UVC and warned that the UVC needed to be withdrawn from the right atrium. Unfortunately, this warning went unheeded and the newborn sustained brain damage from interrupted blood flow.
Dempsey and Kingsland action
We obtained the hospital records and films and took depositions of the health care providers who participated in P. B.’s care to confirm the above facts. In reviewing the hospital’s chart, we noted that the record which described the UVC placement recited that the placement was performed “pursuant to unit protocol.” We requested this protocol be produced for our review but the hospital refused, denying that the protocol existed. After the Judge reviewed our motion to compel production of the protocol and heard argument from the parties, the judge ordered the hospital to produce the protocol or face sanctions. It became apparent that the hospital refused to produce the protocol because its placement of the UVC in P. B. squarely violated the protocol’s directives. We also developed an animation to show how a UVC should be placed so as to prevent injury. The animation also showed how an erroneously placed UVC results in perforation of the heart wall, fluid collection in the pericardium and then cessation of heartbeat interrupting blood flow and resulting in damage to the brain and other organs.
The case settled pursuant to an agreement which requires that the settlement amount remain confidential.