Tracheostomy Care: Nurses Failed To Report Stoma Site Bleeding To The Physician.

Tracheostomy Care: Nurses Failed To Report Stoma Site Bleeding To The Physician.

Legal Eagle Eye Newsletter for the Nursing Profession

March 2018

The patient’s estate’s nursing expert testified that it is a nursing responsibility to keep a tracheostomy patient’s airway clear through suctioning as needed and to monitor the stoma site and keep it clean. Any occlusion of a tracheostomy that cannot be cleared with suctioning must be reported to the physician immediately.

Bleeding at the stoma site is especially problematic due to the possibility of a blood clot forming in the trachea which can stop the patient from breathing. The estate also had expert testimony from a physician that after the patient’s medical procedure it was her physician’s responsibility to contact the nurses at the hospital as to her condition. The nurses would have alerted him to the bleeding at her stoma site, which would have prompted him to return to the hospital to examine the patient and perform additional cauterization and packing to stem the bleeding. The blood clot in the patient’s trachea caused arrest which left her with brain damage and partial paralysis. APPELLATE COURT OF ILLINOIS February 6, 2018

The patient had to be admitted to the hospital for Ludwig’s angina, a life-threatening condition in which an abscess causes swelling in the floor of the mouth and in this patient’s case caused swelling of the neck and her airway. To perform surgery to correct the condition a tracheostomy was necessary while the patient was unable to breathe through her nose or mouth in the operating room and during post-operative recovery.

This patient’s case was complicated by the fact she had been on long-term blood-thinner therapy before coming to the hospital, making her more prone to excessive uncontrolled bleeding.

The surgery went well. However, afterward the nurses observed some bleeding and bloody drainage at the stoma site.

Five days later she was taken to the cath lab to test her artificial heart valve. During that procedure significant bleeding started at the tracheostomy stoma site. The physicians cauterized and repacked the site with gauze. That evening the bleeding continued but the evening and night nurses only gave the patient’s sister gauze and then towels to soak up the blood. The patient was also coughing up blood clots. The patient’s trache tube was not inflated and she was able to complain that she felt like she was choking. Finally the night nurse called the physician, who contacted a resident on duty in the hospital to go to the room. The resident called a code, but he had grave difficulty ventilating the patient with an Ambu bag because of clotted blood in the trachea.

The patient left the hospital with profound anoxic brain damage and partial paralysis from a twenty-minute arrest. The jury awarded the patient’s estate over $22,000.000 as damages from the hospital. The Appellate Court of Illinois ruled $15,000,000 of that was not supported by the evidence, but left a $7,000,000 award to the family intact. Jefferson v. Hospital, __ N.E. 3d __, 2018 WL 769090 (February 6, 2018).