Failure to Ensure Timely IV Midline Maintenance and Dressing Changes
Penalty
Summary
The facility failed to ensure the appropriate and timely administration and maintenance of an intravenous (IV) midline catheter for a resident with multiple complex medical conditions, including diabetes, acute kidney failure, necrotizing fasciitis, osteomyelitis, sepsis, and chronic ulcers. The resident was ordered to receive IV antibiotics and saline flushes through a midline catheter, but after the completion of the antibiotic course, there were no physician orders for continued flushing to maintain line patency or for regular IV dressing changes. Documentation showed that the last antibiotic dose and saline flush were administered several days prior, and there was no record of any IV dressing changes during the period reviewed. Observation revealed that the resident's IV dressing had not been changed since insertion, and the IV tubing and bag remained hanging on the pole days after the last use. The resident confirmed not receiving any IV medications or flushes in several days, and the dressing had never been changed. An LPN interviewed was unable to locate any orders for dressing changes and confirmed the dressing was outdated. Facility policy required midline catheters to be flushed at least every 24 hours and dressings to be changed within 24 hours of insertion and then every five to seven days, but these protocols were not followed.