Case report: case of operation on child with osteogenesis imperfecta (brittle bones)

Settlement: £8,400

The Claimant was born on 15 May 1995 and has osteogenesis imperfecta (brittle bones) which causes her to suffer frequent long bone fractures. She also suffers from a complex neurological abnormality caused by displacement of her first cervical vertebra at the base of her brain.

In October 2003 the Claimant was admitted to a Children’s Hospital for nailing of her right humerus. She had a low profile Portacath central venous line in place of 0.8mm internal diameter.

The nailing of the right humerus was carried out on 1 October 2003 under general anaesthetic without incident. The Portacath was used for some of the anaesthetic drugs which included propofol and atracurium.

The operation of 1 October 2003 was unsuccessful and a revision was required. This was carried out under general anaesthetic of 9 October 2003.

Anaesthesia was induced using thiopentone 125 mg, fentanyl 100 μg and atracurium10 mg via Portacath and the Claimant was intubated easily following which her lungs were ventilated artificially with oxygen, nitrous oxide and isoflurane.

On 10 October 2003 the charge nurse de-accessed the Portacath. He subsequently completed an Incident Report form stating that at 13.00 he had attended the Claimant in order to deaccess her Portacath and that he had taken a blood sample from the line and then flushed it with 10 mls 0.9% saline followed by 5 mls Heplock solution. As the line was locked, the Claimant “appeared vacant with limbs twitching”. He noted that she was able to hear verbal commands but was unable to see. He noted that she became cyanosed with profound bradycardia. He gave oxygen and tried to stimulate her. He noted that her blood pressure remained normal and her oxygen saturation recovered to 91 – 97% on oxygen. She recovered “over 5 minutes”. He noted that afterwards the Claimant said that she had “felt funny” as the last bit of flush was injected. He noted that the Doctor had been contacted and that he had not been sure whether the line had been flushed following anaesthetic use. He added that he had had a previous experience of children returning to the ward with propofol remaining within Portacaths. He stated that he had “seen this situation before” and now would refuse to deaccess such lines unless an anaesthetist had documented that the line had been properly flushed.

It was noted that the Claimant had suffered a brief period of syncope with a loss of consciousness, cyanosis and shakes lasting 5 minutes and followed by full recovery. This had been triggered by flushing the Portacath.

It was noted that the Portacath had been flushed in theatre and only used for the induction of anaesthesia “but it certainly sounds likes she received a very small dose of muscle relaxant. It seems possible that there was a small residuum of an anaesthetic drug – fentanyl or atracurium– and that the more thorough flush given to take out the gripper needle was enough to remove it.

The anaesthetic critical incident form completed by the Doctor was not signed or dated.

The claim settled for £8,400 of which £400 was special damages payable to Claimant’s mother and Litigation Friend.