Failure to Change Midline Catheter Dressing with Gauze per Standards
Penalty
Summary
A deficiency was identified when a resident with a left upper arm single lumen midline catheter was observed with a dressing dated seven days prior, and gauze was present under the transparent semi-permeable dressing. According to the physician's order, the dressing was to be changed within 24 hours of admission, insertion, or reinsertion, and then every seven days or as needed, using sterile technique. The order also specified that dressings with gauze should be changed every two days. However, the dressing with gauze remained in place for at least seven days, contrary to both the physician's order and professional standards of practice. Interviews with facility staff revealed a lack of knowledge regarding the appropriate frequency for changing midline catheter dressings, particularly when gauze is used. The LPN interviewed was unaware that dressings with gauze required more frequent changes, and the DON confirmed that such dressings should be changed every two days. The facility was unable to provide a midline catheter policy and procedure upon request. Review of CDC guidelines also indicated that dressings should be replaced when soiled or when gauze is used, supporting the need for more frequent changes than what was observed.