Quality concerns raised over IV cannulas in Tamil Nadu government hospitals

In recent months, serious concerns have emerged over the quality and safety of intravenous (IV) lines, including peripheral IV cannulas, supplied to a number of government hospitals across Tamil Nadu. Numerous incidents of cannulas breaking, leaving the plastic fragments inside patients’ veins, have raised questions about the safety of these devices among government doctors.

After incidents of frequent IV line failures surfaced, The Hindu tracked the issue for two months and reached out to government doctors across the State. Several of them, including those working in hospitals in the State capital, Chennai, confirmed incidents in which IV cannulas had broken, leaving fragments lodged in patients’ veins. Most cases required imaging assistance and minor surgical procedures to retrieve the retained catheter parts. Similar quality issues with central venous lines used in nephrology departments have also been reported in a delta district.

Intravenous cannulas are used to administer fluids and medications directly into a vein. It has a sharp metal needle, called a stylet, that pierces the skin and vein to guide a plastic tube (the cannula) into the vein. Once the cannula is in place, the metal needle is removed, leaving the plastic tube inside the vein to allow continuous delivery of fluids or medications.

Surgical intervention

A senior doctor from a district in north Tamil Nadu witnessed two such incidents recently. “In one patient, after the IV fluid administration was completed, we attempted to remove the cannula. However, it broke, and the plastic segment remained inside. Under local anaesthesia, we made an incision and removed it. In another patient, the metal tip broke and remained in the vein. We took the patient to the operation theatre, and under IV anaesthesia, we probed and retrieved it with the surgeon’s help,” the doctor said, requesting anonymity.

Another doctor in Chennai said some cannulas had broken even during routine handling. “There have been instances during removal and while changing IV sets. They leave fragments inside, and we have removed the broken parts through minor surgical procedures. We have been noticing such cases for the past year, with around four to five cases per month at our centre,” he said. In another hospital, a doctor said such incidents had been occurring at least twice a month.

While a few doctors acknowledged that other factors could also contribute to cannula fractures, they said the frequency of such breakages in government hospitals appeared to be rising primarily due to quality issues.

Guidewire malfunctions

Problems were also reported with central venous lines used in nephrology departments. A doctor from central Tamil Nadu described guidewire malfunctions in which the wire often got stuck during insertion, making it difficult to advance or withdraw and increasing the risk of vascular injury. “The tissue dilator in the kit fails to dilate adequately, and the catheter lacks sufficient stiffness. It bends easily during manipulation, particularly when the patient moves their neck. This compromises catheter positioning, increases the risk of malfunction, and often necessitates reinsertion,” he said.

Several doctors and nurses also pointed out that, in some cases, IV infusion sets and syringes lacked quality. In a few centres, endotracheal tubes used for intubation were found to be of poor quality, putting patients at risk of vocal cord injury and local necrosis (the death of tissue in a specific, localised area of the body).

Sources said that no complaints of this nature were reported to the Tamil Nadu Medical Services Corporation earlier. Despite repeated attempts, health officials could not be reached for comment.