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Accident or negligence?

01 February 2005

Mr G was taking anticoagulants following a renal transplant and stroke some years earlier. He attended Dr P’s surgery, where the nurse practitioner was to take a blood sample.

Noticing that the vein normally chosen for sampling was becoming scarred, the nurse practitioner suggested an alternative site on the patient’s right arm. During the procedure, Mr G complained of pain in his arm.

Realising that she had accidentally punctured the brachial artery, the nurse practitioner bandaged the arm tightly. She then sought advice from one of the practice GPs, who checked the arm and bandage before allowing Mr G to go home.

However, later the same day Mr G returned, complaining of a very bruised right arm and a cold feeling in his hand with altered sensation.

He was seen by a second GP who, suspecting an arterial bleed, arranged immediate admission to hospital. A large haematoma was diagnosed and for the next three months Mr G experienced some weakness in his dominant hand.

He began proceedings against the GP partners, including Dr P, who incidentally had had no involvement with the patient. All the partners were held responsible for the actions of their employee – the nurse practitioner – who, it was alleged, had been negligent in taking a blood sample from a site where there was a danger of puncturing the brachial artery, and had not exercised reasonable skill and care in performing the procedure.

Expert opinion

After seeking the expert opinions of a neurologist and a GP, we resolved to defend the case. They felt that the nurse practitioner had exercised a reasonable standard of care. In the view of the expert in neurology, the inadvertent sampling of the brachial artery ‘is an unusual occurrence but one that can be made by a reasonably competent clinician’.

Mr G dropped the claim before it came to trial.