‘Normal practice’ to give Raychel low sodium drip

Raychel died after developing hyponatraemia - a shortage of sodium in the blood - after a saline drip was administered in the wake of a routine appendix operation at Altnagelvin almost 12 years ago.

The nine-year-old was taken off the sodium-rich Hartmann’s Solution (131mmol/l) and fed the lower sodium content, Solution No 18 (30mmol/l), after her uneventful appendix operation.

Outlining the terms of reference of the Inquiry into Hyponatraemia Related Deaths in Northern Ireland (IHRDNI) early last year, Chairman John O’Hara, said it would, in Raychel’s case, eventually consider: “The reason for and justification of the change from Hartmann’s solution that had initially been prescribed for her during her surgery to Solution No.18 that was administered to her on the ward.”

Today (Wednesday, February 27) the IHRDNI published a written statement submitted by Ms Marian McGrath who was a Theatre Nurse in Altnagelvin and along with Staff Nurse Ayton, led nursing care in theatre during Raychel’s appendectomy.

In the statement she states that Raychel underwent a relatively routine appendix operation.

Before her operation Raychel had been “receiving intravenous fluids No. 18 solution in the ward,” Ms McGrath stated.

However: “These fluids were discontinued before coming to theatre as was normal practice. I was informed the fluids had been up for about an hour.”

When she was moved to the operating table Raychel was given the higher sodium content Hartmann’s Solution.

Explained Ms McGrath: “Dr Claire Jamison the anaesthetic Senior House Officer was also present in theatre. At this stage one litre of Hartmann’s Solution was attached to the venflon in the right arm via a paediatric giving set and the infusion commenced.”

The head theatre nurse stated that Raychel was then administered with anaesthetic, Voltarol and Paracetamol and her “operation proceeded uneventfully.”

After the operation her heart rate, breathing and oxygen saturation were all observed to be normal

At this point as medical staff tried to nurse Raychel to recovery she was still receving an infusion of Hartmann’s Solution.

According to Ms McGrath: “Dr Jamison was present in theatre while Raychel was being recovered. When she awoke Raychel was not in any pain and did not feel sick therefore she did not require any drugs in recovery.

“At 1.30am Raychel was ready to go back to the ward so I rang for the nurse to take her back.”

It was at this point that “the Hartmann’s Solution was discontinued with fluids to be recommenced on ward,” explained Ms McGrath.

She then gave the ward nurse a report including the findings at surgery and checked post-operation pain relief was accounted for.

Ms McGrath revealed that it was considered normal practice that children returning to ward from surgery in Altnagelvin should be prescribed the lower sodium content Solution No. 18.

“Finally, I checked the fluid balance chart and anaesthetist’s verbal instructions which stated that No. 18 solution, which was in progress pre-op should be re-commenced on return to the ward.

“In my experience children were given Solution No. 18 in ward prior to surgery,” she stated. “In surgery and recovery they were given Hartmann’s solution.

“This was discontinued when they left recovery and Solution 18 was recommenced in ward, which in my experience was in accordance with normal practice,” she concluded.