UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #12

DNA Solves
DNA Solves
DNA Solves

New Posts

Status
Not open for further replies.
Sweeper2000 said:
I’m wondering guys about the possibility that it could be malpractice at work or In practice here. We have heard that ae can be associated with inserting equipment etc but doing it improperly. I still don’t really understand the equipment here for instance don’t see how the air bypasses the monitor but before the pump. I have found this though so thought it might be worth considering. im saying this because I still find her lack of awareness about the way people may be looking at her as really noticeable.

www.gov.uk

Needle-free intravenous connectors - incompatibility and risk of infection

(All manufacturers) some pre-filled glass syringes are incompatible with some needle-free connectors; and when adaptor stays attached after use there is a possible risk of infection and or air embolus to patients. (MDA/2011/068)
www.gov.uk www.gov.uk

<modsnip>
Click to expand...

All the following IMO.

I'm not sure I totally understand all you've written, but here's my take on it. Baby M had a basic intravenous infusion, which is almost always sited in a hand or foot in neonates. The tubing from the bag of fluid is flushed through then threaded through a pump. The monitor which detects air is part of the pump.
 
Last edited by a moderator:
marynnu said:
All the following IMO.

I'm not sure I totally understand all you've written, but here's my take on it. Baby M had a basic intravenous infusion, which is almost always sited in a hand or foot in neonates. The tubing from the bag of fluid is flushed through then threaded through a pump. The monitor which detects air is part of the pump.
Click to expand...
That’s it Mary thankyou. It’s the port through which as alleged the air must have gone through I’m not understanding. No experience with such things. That’s why I asked in the other thread if it was a similar port to one used for bloods. Could visualise how air might be forced through without the monitor going off as it’s after the pump. Thought this info link was applicable and might give an explanation for the AE. Especially if someone wasn’t doing their job as per protocol.

www.gov.uk

Needle-free intravenous connectors - incompatibility and risk of infection

(All manufacturers) some pre-filled glass syringes are incompatible with some needle-free connectors; and when adaptor stays attached after use there is a possible risk of infection and or air embolus to patients. (MDA/2011/068)
www.gov.uk www.gov.uk
 
Sweeper2000 said:
That’s it Mary thankyou. It’s the port through which as alleged the air must have gone through I’m not understanding. No experience with such things. That’s why I asked in the other thread if it was a similar port to one used for bloods. Could visualise how air might be forced through without the monitor going off as it’s after the pump. Thought this info link was applicable and might give an explanation for the AE. Especially if someone wasn’t doing their job as per protocol.

www.gov.uk

Needle-free intravenous connectors - incompatibility and risk of infection

(All manufacturers) some pre-filled glass syringes are incompatible with some needle-free connectors; and when adaptor stays attached after use there is a possible risk of infection and or air embolus to patients. (MDA/2011/068)
www.gov.uk www.gov.uk
Click to expand...
The port would be near the baby. All you have to do to inject is to clamp the line & silence the pump - if the clamp is on it alarms.
Glass syringes are never used with neonates.
 
https://twitter.com/MrDanDonoghue
Report from today’s evidence, court now adjourned till Monday

"Asked how much insulin would be needed to cause the low blood sugar levels in Child L, Prof Hindmarsh said: "I have taken quite a conservative view of this, but I would suggest you could add somewhere in the region of 10 units of insulin to a bag, that would be sufficient to produce the hypoglycaemic effect that was measured in the sample.

"Vials of insulin contain 100 units per millilitre, so the volumes we're talking about are quite small and not noticeable on a routine stock check. [...]

Prof Hindmarsh said insulin could be added "fairly easily" through a portal that's located at the bottom of the feed bags.

He told the court that in his opinion, to produce the blood glucose levels detected, around at least three or potentially four bags could have been contaminated."

Lucy Letby: Baby's blood sugar dangerously low, trial told
 
Does it mean that ALL bags with glucose in the fridge were contaminated with insulin? o_O

Sorry, I couldn't follow closely today.
 
"A medical expert told Manchester Crown Court that the youngster, Child L, suffered a hypoglycaemic episode which lasted from the morning of April 9 2016 to the middle of the afternoon on April 11."

[...]

Jurors heard the dextrose concentration was increased as medics tried to bring Child L’s blood sugar levels up – which necessitated a change of bag – and the rate of infusion was also stepped up.

Prof Hindmarsh said despite that there was “not really much change in the glucose measurements which would imply there was ongoing insulin present and ongoing insulin action”.

He told the court that insulin could “potentially” have been added to at least three dextrose bags if the giving sets were also changed.

Prof Hindmarsh also raised the possibility that if the giving set remained the same then insulin could stick to its plastic, come off and then release into the bag.

He agreed with Ben Myers KC, defending, that “sticky insulin” would eventually run out."

Mr Myers asked: “It is the case that sticky insulin could be operative over a similar period?”

Prof Hindmarsh replied: “I don’t think anyone has done this sort of study to be honest. I think the answer is I don’t know.”

He told Mr Myers the “relatively steady” blood sugar levels did not seem to be influenced by the increased infusion rates.

Mr Myers asked: “Would that be more consistent with it being added to the bag as you go on, rather than the sticky insulin?”

Prof Hindmarsh replied: “Yes.”

[...]

more to read at links (PA)
Evening Standard - Baby had dangerously low blood sugar levels over three days, Letby trial told
Independent - Baby had dangerously low blood sugar levels over three days, Letby trial told
Belfast Telegraph - Baby had dangerously low blood sugar levels over three days, Letby trial told
 
As with baby F, IMO, the most important time is to know when the contamination started, not when it ended.

In the case of baby F it lasted for 17 hours, in the case of baby L it lasted for 2 1/2 days. It could only be achieved with multiple bags, whatever the chances were that these could go to other babies. Bags placed on top or at the front of a shelf to be the one most likely to be selected next would have to be my guess.
 
Tortoise said:
As with baby F, IMO, the most important time is to know when the contamination started, not when it ended.

In the case of baby F it lasted for 17 hours, in the case of baby L it lasted for 2 1/2 days. It could only be achieved with multiple bags, whatever the chances were that these could go to other babies. Bags placed on top or at the front of a shelf to be the one most likely to be selected next would have to be my guess.
Click to expand...
You're absolutely right about when the contamination started. At least with Baby L we can pinpoint it more easily. The problem is with the bag which was changed at about 04.00 on 10th or any bags after that, in my view. Because of how bags of 10% glucose are sealed I feel it's quite tricky to use the port if they're unopened. And relying on the right bags being used after you've gone home seems very hit & miss.
It does make you wonder if the effects of such mind-boggling levels of insulin can last longer than anybody really knows.
 
Last edited:
Tortoise said:
"A medical expert told Manchester Crown Court that the youngster, Child L, suffered a hypoglycaemic episode which lasted from the morning of April 9 2016 to the middle of the afternoon on April 11."

[...]

Jurors heard the dextrose concentration was increased as medics tried to bring Child L’s blood sugar levels up – which necessitated a change of bag – and the rate of infusion was also stepped up.

Prof Hindmarsh said despite that there was “not really much change in the glucose measurements which would imply there was ongoing insulin present and ongoing insulin action”.

He told the court that insulin could “potentially” have been added to at least three dextrose bags if the giving sets were also changed.

Prof Hindmarsh also raised the possibility that if the giving set remained the same then insulin could stick to its plastic, come off and then release into the bag.

He agreed with Ben Myers KC, defending, that “sticky insulin” would eventually run out."

Mr Myers asked: “It is the case that sticky insulin could be operative over a similar period?”

Prof Hindmarsh replied: “I don’t think anyone has done this sort of study to be honest. I think the answer is I don’t know.”

He told Mr Myers the “relatively steady” blood sugar levels did not seem to be influenced by the increased infusion rates.

Mr Myers asked: “Would that be more consistent with it being added to the bag as you go on, rather than the sticky insulin?”

Prof Hindmarsh replied: “Yes.”

[...]

more to read at links (PA)
Evening Standard - Baby had dangerously low blood sugar levels over three days, Letby trial told
Independent - Baby had dangerously low blood sugar levels over three days, Letby trial told
Belfast Telegraph - Baby had dangerously low blood sugar levels over three days, Letby trial told
Click to expand...
Can someone explain what “sticky insulin “ is please? What are the other types of insulin ? When would you use different types?
 
Just trying to get my head around this multiple bags being poisoned business. Hopefully someone more knowledgeable can chime in.

I feel lots of doubt around the idea that LL poisoned a bunch of glucose bags on the off chance that they’d be changed on her day off. I also doubt she poisoned a second TPN bag for child F, but that’s another matter altogether.

How often are these babies prescribed dextrose on these wards? And how is dextrose stored? Does it make more sense that the dextrose had been spiked with insulin, meaning each time 2 nurses made up a new glucose bag with increased dextrose, they were also adding a proportionate amount of insulin to the bag?

JMO but it feels like the most straightforward explanation.
 
GoodDayToYouSir said:
Can someone explain what “sticky insulin “ is please? What are the other types of insulin ? When would you use different types?
Click to expand...
It’s the issue they talked about in opening speeches. The idea that insulin gets stuck on the plastic lines/tubes of the machine, and therefore keeps seeping into the child even after the poisoned bag is removed.

At the time I was hoping they would have actually tested this on a machine to recreate it, but looks like they have not.
 
So at least 3 bags contaminated - does that mean all in one go or as and when a new bag was set up for L specifically?

Edit: saw this is already being discussed. IMO i imagine the bags would have been containment individually rather than in bulk - unless other babies at the time were experiencing high insulin levels which I don't believe they were. I think it was targeted IMO
 
GoodDayToYouSir said:
Can someone explain what “sticky insulin “ is please? What are the other types of insulin ? When would you use different types?
Click to expand...
Looks like it's just a term Myers used/made up to describe insulin that was added to the bag but then could have stuck to the plastic of the giving set:

"Prof Hindmarsh also raised the possibility that if the giving set remained the same then insulin could stick to its plastic, come off and then release into the bag.

He agreed with Ben Myers KC, defending, that “sticky insulin” would eventually run out.

Mr Myers asked: “It is the case that sticky insulin could be operative over a similar period?”

Prof Hindmarsh replied: “I don’t think anyone has done this sort of study to be honest. I think the answer is I don’t know.”

He told Mr Myers the “relatively steady” blood sugar levels did not seem to be influenced by the increased infusion rates.

Mr Myers asked: “Would that be more consistent with it being added to the bag as you go on, rather than the sticky insulin?”

Prof Hindmarsh replied: “Yes.”"

 
marynnu said:
You're absolutely right about when the contamination started. At least with Baby L we can pinpoint it more easily. The problem is with the bag which was changed at about 04.00 on 10th or any bags after that, in my view. Because of how bags of 10% glucose are sealed I feel it's quite tricky to use the port if they're unopened. And relying on the right bags being used after you've gone home seems very hit & miss.
It does make you wonder if the effects of such mind-boggling levels of insulin can last longer than anybody really knows.
Click to expand...
So he was receiving 10% glucose on the morning of 9th April, LL's day shift - this is when the contamination started.
The blood sample was taken for the lab at 3.35pm.
He was put on 12.5% dextrose at 4.30pm that same shift. LL was still at work at 9.22pm that evening.
He was put on 15% dextrose at 6am that night shift 9th/10th.
His blood sugars came up to 3.0 by 2pm on 10th but then fell back again and didn't come back up to above 3.0 until 3pm on 11th.

So the first two bags were applied during LL's shift, and the last was applied on the night shift following her day shift.

That's what we were told in the electronic evidence. I don't know how many additional boluses of glucose might have been administered at different times, seems there might be gaps in the reporting. JMO
 
Last edited:
Status
Not open for further replies.

DNASolves

Who is Escambia County John Doe (1989)?

Staff online

Members online

... and 207 more.
Total: 1,048 (members: 208, guests: 840)

Online statistics

Members online
208
Guests online
840
Total visitors
1,048
Totals may include hidden visitors.

Forum statistics

Threads
598,311
Messages
18,079,309
Members
230,605
Latest member
ahtnamaS_06
Back
Top