Failure to Perform and Document Weekly PICC Line Care and Measurements
Penalty
Summary
The facility failed to ensure that peripherally inserted central catheter (PICC) line dressings were changed and mid-arm circumference measurements were completed and documented every seven days for two of three sampled residents reviewed for PICC line care and maintenance. For one resident, the PICC line dressing was observed to be dated ten days prior to the survey, with no documentation of dressing changes or mid-arm circumference measurements since the line was inserted. There were also no physician orders for PICC line sterile dressing changes or mid-arm circumference measurements found in the medical record. The resident had diagnoses including orthopedic aftercare following surgical amputation and severe protein-calorie malnutrition, and was severely cognitively impaired, receiving IV medications through the PICC line. For another resident, the PICC line dressing was observed to be nine days old, and there was no documentation of mid-arm circumference measurements or dressing changes since the initial insertion, except for one documented dressing change shortly after insertion. The physician order for weekly dressing changes had been discontinued after a hospital transfer and was not resumed upon the resident's return, despite ongoing IV medication administration. The Director of Nursing confirmed that standard orders for PICC line care and maintenance, including weekly sterile dressing changes and documentation, should have been in place and followed for all residents with PICC lines.