Failure to Follow Midline Catheter Care Standards and Documentation
Penalty
Summary
The facility failed to provide care for midline catheters in accordance with professional standards for three residents who required intravenous (IV) treatments. For one resident with a history of urinary tract infection and bladder cancer, there was a lack of documentation regarding the flushing of the midline catheter before and after medication administration, as well as after discontinuation of IV antibiotics. The medication administration record (MAR) did not show that flushes were performed as ordered, and there was no assessment or documentation of the IV line’s length or the condition of the catheter tip during dressing changes or after removal. The Director of Nursing (DON) acknowledged the absence of required documentation and orders related to flushing and assessments. Another resident with a urinary tract infection had a midline IV inserted for antibiotic treatment, but there were no physician’s orders for weekly dressing changes, site assessments, or normal saline flushes at the time of insertion. The MAR indicated that several doses of the prescribed antibiotic were not administered, and there was no documentation explaining the missed doses. Additionally, there was no record of who inserted the heparin lock or when the midline was placed. The DON confirmed that the medication was available in the emergency drug kit but was not used, and the physician was not notified about the missed doses. A third resident with rhabdomyolysis and peripheral vascular disease also experienced deficiencies in midline care. The MAR showed missed doses of prescribed antibiotics, and there was no documentation of the midline’s length or its discontinuation, nor was there an assessment of the site and line after removal. The facility’s central line care policy required physician orders for all treatments, documentation of line removal, and measurement of the line, but these standards were not met for the residents reviewed.