United Christian Hospital announces expert review findings on incident relating to complications case
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The spokesperson for United Christian Hospital (UCH) announced the findings of an expert review today (April 30) regarding a 16-year-old female patient who developed complications while receiving clinical treatment:
A 16-year-old female with no underlying chronic illness was admitted to UCH through the accident and emergency department in the morning on October 31, 2017 with head and neck pain and right-sided weakness. She was transferred to the paediatric intensive care unit due to increasing limb weakness and respiratory failure in the afternoon of the same day. Multi-disclipinary consultations were conducted to find out the underlying causes. On November 9 magnetic resonance imaging of the brain and spine was performed again and the patient was diagnosed to have acute transverse myelitis.
Treatment was given but without significant improvement. Clinicians conducted an interview with patient’s family on November 15 to discuss plasmapheresis to improve the patient's respiration and limb power. Before undergoing plasmapheresis, a central venous catheter is inserted into the patient’s right internal jugular vein. Possible risks and complications include arterial puncture, vascular occlusion, pleural effusion and haemothorax. With the consent of the patient's family, the procedure for central venous catheter was performed on November 16. The procedure was complicated by bleeding from intrathoracic major blood vessels, resulting in a decrease in blood pressure and haemothorax. The patient was transferred to Queen Elizabeth Hospital (QEH) for further treatment that afternoon. She is currently in a stable condition and will undergo a series of rehabilitation treatments in QEH including thoracic physiotherapy, limb movement training and speech therapy.
The UCH is very concerned and saddened about this incident. With the assistance of the Hospital Authority Head Office, the Vice-chairman of the Hospital Authority Central Coordinating Committee in Paediatrics and Chief of Service of Department of Paediatrics at Prince of Wales Hospital, Dr So King-woon, was commissioned to thoroughly review the clinical management and medical procedure of the patient, during which comments of experts from related specialties were also sought.
Summarising the various findings and comments, Dr So pointed out that the doctor inserted the needle into the patient’s right internal jugular vein under ultrasound guidance. Blood was then aspirated to confirm the needle was inserted into the right internal jugular vein but not the artery. He said he believes that the guidewire or the dilator might have gone through the internal jugular vein into the subclavian artery and damaged the artery, causing haemothorax. Dr So said that according to relevant literature, complications such as carotid and subclavian arterial puncture during internal jugular vein catheterisation have occurred from time to time. However, subsequent thromboembolic complication and cerebral stroke following subclavian artery injury cannot been found in any related literature, he added.
He also said that at the time when the patient developed haemothorax, UCH immediately contacted QEH to conduct a joint consultation and arrange for the patient to be transferred to QEH. After a further CT scan, a clearer image of right subclavian artery puncture was obtained. The transfer arrangement and diagnosis caused no delay to the patient's cardioneurology operation, which was performed at QEH on November 29.
Dr So also referred to the patient's transfer from UCH for QEH. Upon arriving at the paediatric intensive care unit at QEH, a decrease in the patient's conscious state was found by clinicians. A CT scan of the brain was arranged and acute ischaemic stroke was diagnosed. In view of the fact that the patient had experienced a large stroke with a high risk of bleeding, tissue plasminogen treatment was not appropriate. The patient thus underwent brain surgery by a QEH neurosurgeon that night. The extent of the stroke and pre-existing internal bleeding rather than the timing of stroke diagnosis were the major factors in affecting the decision regarding implementation of tissue plasminogen treatment on this patient.
This case involved very rare complications. Nonetheless, Dr So suggested that in future, hospitals should particularly point out to the patient and patient's family that central venous catheter insertion could result in stroke, and the hospital should remind frontline clinicians to pay special attention to stroke symptoms after the insertion of a central venous catheter.
Dr So, together with the Deputy Hospital Chief Executive of UCH, Dr Li Kai-ming, met with the patient's family last Friday to explain in detail the expert review findings.
The Hospital Chief Executive of UCH, Dr Tom Kam-tim, said he is saddened by the unforeseeable and unfortunate complications developed during the clinical procedure and expressed an apology to the patient and her family for their pain and suffering. The hospital will review and strengthen the communication between clinical departments and patients as well as patient’s family on the communication of risks related to central venous catheter insertion, and will also seek improvement measures on providing psychological support to a patient’s family upon the development of complications. UCH would like to express its deep sympathy to the patient and her family again and will continue to communicate with the patient and her family to ensure that she continues to receive appropriate treatment and necessary assistance.
Ends/Monday, April 30, 2018
Issued at HKT 18:24
Issued at HKT 18:24
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