Failure to Flush IV Catheters as Ordered
Penalty
Summary
The facility failed to ensure the safe and appropriate administration of IV fluids by not flushing a resident's peripherally-inserted central catheter (PICC) and midline catheter as ordered by the physician and as required by facility policy. The policy, dated January 31, 2025, specified that central venous and midline catheters should be flushed at regular intervals to maintain patency. For a resident with a diagnosis of anemia who was cognitively intact and required assistance with care, physician orders directed staff to flush the midline and PICC with 10 ml of normal saline every shift for maintenance purposes. Review of the resident's Medication Administration Records (MARs) for February, March, April, and May 2025 revealed multiple instances where there was no documented evidence that the required flushes were performed during specific shifts. These omissions were confirmed by the Director of Nursing, who acknowledged the lack of documentation for the required catheter flushes on the identified dates and shifts. The failure to follow physician orders and facility policy resulted in a deficiency under 28 Pa. Code 211.12(d)(1)(5) Nursing Services.