Closed Claims Case 2024-12: IV Infiltrations and Extravasations

An ASA 3 patient with a BMI 45 received general anesthesia (GA) for a cranioplasty. The antecubital I.V. was placed with ultrasound by a provider who was not part of the anesthesia team. There was no documentation of any difficulty, but the attending anesthesiologist was not aware that a standard-length I.V. had been placed in a relatively large arm with ultrasound guidance. Anesthesia was induced uneventfully and maintained with sevoflurane. The patient's arms were secured such that the I.V. site was not visible. The administered medications had the expected effect throughout the case. Mannitol was administered with an infusion pump without triggering a pressure alarm. At the end of the anesthetic, the forearm distal to the I.V. was swollen and tense and the patient complained of pain in her arm. The anesthesiologist consulted with a hand surgeon who diagnosed compartment syndrome and the need for fasciotomy. The anesthesiologist placed a...