VENEPUNCTURE

Mundane and common as the procedure is, faulty placement of a needle or catheter in a vein can occasionally lead to devastating consequences.

A prestigious academic English journal recently published an article[1] deploring the lack of formal training of medical students in the procedure, and suggesting that consequent damage to venous access might be actionable for some diabetic and renal patients.

Some substances, relatively innocuous in the bloodstream, can cause intense irritation outside a blood vessel. Intravenous Contrast Media, used for outlining blood vessels on radiographs, may cause inflammation of the skin and underlying tissues[2]. Usually the problem is short-lived, but more permanent complications such as Reflex Sympathetic Dystrophy may occur in susceptible patients.

The needle need not even be outside the vein to cause problems: simply transfixing the back wall may be enough to weaken the vessel. High pressure injection may complete the process, allowing significant leakage outside the vessel.

Even in the absence of irritants, persistent impaling of the back wall or valve[3] of a vein during venepuncture or intravenous injection can be very painful. Feelings of faintness may then progress to loss of consciousness and, on rare occasions, even cardiac arrest [4], [5]. 

Some of these serious complications may be caused by malignant vasovagal syncope [6].

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