Our client was a 16 year old male who had been badly injured in a farming accident. He presented to the emergency department with a burst fracture at the C4 vertebrae of his neck and a spinal cord injury. Surgeons at the hospital performed a surgical fusion of his neck injury. Afterward, he was admitted to the ICU.
In the ICU, a PEG tube was placed for his feeding. The PEG tube was feeding at 60cc's/hr. The standard of care requires that nurses check a patient's PEG tube for proper placement, signs of residual, and infection. Nursing notes show, however, that the PEG tube was checked sporadically, with periods where there were no checks, whatsoever. Our client was a quadriplegic; the nurses had to lift him in order to turn and bathe him. It was during these transfers that our client's PEG tube was negligently dislodged. The tube was not found to be dislodged because the nursing staff was not regularly performing the required PEG tube checks.
After 5 days in the ICU, it was noted that our client vomited, but there were no notes of checking the PEG tube for displacement or residual. It was also noted on this date that his abdomen is soft with no bowel sounds in all four quadrants. The next day there were still no bowel sounds, but the abdomen was firm and distended. On the next morning, our client again vomited and it was noted that his stomach was distended with no bowel sounds. A CT scan was performed, which revealed that the PEG tube was dislodged. His doctor performed an emergency laparotomy. The surgery revealed free air and bilious fluid in the abdominal cavity. The tip of the PEG tube was found to be displaced with the tip of the tube lying outside of his stomach. 800cc's of feeding from the PEG tube were removed from our client's abdominal cavity. The nursing staff failed to perform the proper checks for PEG tube displacement and residual for multiple days. This allowed the feeding tube to release large amounts of feeding material into our client's abdominal cavity.
After our client's emergency laparotomy, he was placed on an air fluidized therapy mattress to help relieve pressure on his bony prominences. This type of mattress does not, however, eliminate the need for the nursing staff to turn and reposition patients. The nursing staff also, mistakenly, placed a cooling blanket beneath our client rather than on top of him. The manufacturer of the therapy bed and cooling blanket warn against this. Placing a cooling blanket beneath a patient on an air fluidized therapy bed negates the pressure relieving effects of the therapy bed. It was well documented in the medical record that the nurses placed the cooling blanket under our client rather than on top of him. Thus, the cooling blanket placement compromised the pressure relief of the mattress.
In addition to destroying the pressure relieving effects of the therapy bed, the cooling blanket reduced the blood flow to the area on our client's rear side. Decreasing the blood flow to an area of high pressure markedly increases the likelihood of decubitus ulcer formation. The placement of the cooling blanket under our client caused a bed sore to form. This resulted in a stage IV decubitus ulcer on our client's buttocks. The nursing staff not only negligently placed the cooling blanket beneath our client, but also neglected to inspect his skin condition and notify his physician of changes.
The severity of our client's decubitus ulcer resulted in multiple surgeries. He had to undergo two debridements and a bone biopsy. Furthermore, he underwent a myocutaneous flap surgery for closure of the wound. He remained on bed rest for six weeks on an air fluidized mattress that was not compromised by a cooling blanket, and eventually the bed sore healed. Todd Townsley, through the use of expert testimony, was able to come to a satisfactory settlement with the hospital and the patient's compensation fund for this client.