A 63-Year-Old Man Admitted for Urolithiasis Complicated by a Urinary

A 63-year-old man admitted for urolithiasis complicated by a urinary tract infection is treated with intravenous antibiotics.  The patient is a Russian-speaking immigrant who lives with his son.  During the night, the nurse sees that one of his intravenous catheters is infiltrated and cannot be used.  The nurse is unable to secure a second peripheral intravenous line and notes that the patient is becoming progressively hypotensive with a blood pressure of 105/50 mm Hg and pulse of 89/min.  He calls the medical resident covering the patient for assistance.  The resident has little experience placing peripheral intravenous lines but has placed several internal jugular lines, including 5 independently, during his intensive care rotations.  The resident asks the patient in English for consent of immediate central line placement.  During the attempt to insert the internal jugular line, the patient develops a large pneumothorax.  In the root cause analysis of this adverse event, which of the following could be the most important patient-related factor?

A) Absence of attending physician
B) Availability of ultrasound equipment
C) Language barrier and communication failure
D) Limited social support system
E) Medicolegal environment

Correct Answer:

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