Failure to Maintain Visible and Clean IV Dressing for Resident with Midline Catheter
Penalty
Summary
A deficiency was identified when a resident receiving intravenous (IV) antibiotics for osteomyelitis was found to have a midline catheter dressing that did not allow for proper assessment of the insertion site. The dressing consisted of gauze, which was soiled with dry blood, covered by a transparent dressing that was stained, wrinkled, and loose at the edges. The insertion site was not visible for assessment, and the dressing had not been changed in accordance with physician orders, which specified weekly changes and as needed if soiled. The resident was unable to recall when the dressing was last changed, and observations over multiple days confirmed the dressing remained unchanged and soiled. Nursing staff reported difficulty in accurately measuring the IV line and arm circumference due to the non-visible insertion site, despite documentation requirements to record these measurements every shift. The Medication Administration Record (MAR) showed inconsistent or missing documentation for arm circumference and dressing changes. The resident's care plan required regular assessment of the IV site for signs of infection or complications, but the site was not visible due to the dressing method used. These actions and inactions resulted in the failure to ensure the safe and appropriate administration of IV fluids and proper monitoring of the IV site.