Unqualified LPNs Removed Midline IV Catheters
Penalty
Summary
The facility failed to ensure that only qualified personnel removed midline intravenous (IV) catheters for two residents who had received IV therapy for urinary tract infections. Both residents were cognitively intact and had midline IV catheters placed at the facility by an outside specialty nursing service. After completion of their IV antibiotic courses, a Licensed Practical Nurse (LPN) removed the midline IV catheters for both residents, despite lacking documented training or qualifications specific to midline or peripherally inserted central catheter (PICC) procedures. Review of the LPN's personnel file showed only basic IV training certification from 2014, with no evidence of midline or PICC-specific training. Facility policy and the Ohio Administrative Code specify that LPNs are not permitted to initiate or discontinue a PICC or any catheter longer than three inches, which includes midline catheters. Interviews with facility staff and the Regional Director of Clinical Services (RDCS) confirmed that the LPN was not qualified to remove the midline IV catheters and that there was confusion among staff regarding the scope of practice for LPNs in this area. The deficiency was identified through record review, staff and resident interviews, and policy review, which collectively demonstrated that the facility did not ensure nurses and nurse aides had the appropriate competencies to care for residents with midline IV catheters. The RDCS acknowledged a lack of IV training for staff and was unaware of the specific state regulations prohibiting LPNs from removing midline catheters. Both residents reported no discomfort or issues following the removal, but the removals were performed by unqualified personnel in violation of state regulations and facility policy.