Failure to Monitor Dialysis Catheter Site
Penalty
Summary
A deficiency was identified when the facility failed to monitor the central venous catheter (CVC) access site for a resident who required dialysis. The resident, who had diagnoses of end stage renal disease and anemia and was dependent on renal dialysis, was readmitted to the facility with a right upper chest catheter for hemodialysis. Although the care plan documented the need to check the access site daily for signs and symptoms of infection, pain, or bleeding, a review of the physician's orders did not show an order to monitor the CVC dialysis site for bleeding, bruising, or signs of infection. Interviews with the DON and a registered nurse confirmed that monitoring the CVC access site is part of facility protocol and should be documented in the electronic system. However, a chart review revealed that the order to assess the hemodialysis site for bruising, bleeding, or symptoms of infection was not entered into the electronic system until after the surveyor's inquiry, indicating that the required monitoring was not in place prior to that time.