Failure to Maintain and Monitor PICC Line for IV Therapy
Penalty
Summary
The facility failed to implement appropriate interventions and orders for the maintenance of a peripherally inserted central catheter (PICC) line for a resident who required intravenous (IV) access for treatment of a wound infection. The resident had significant medical conditions, including diabetes with a foot ulcer, local skin infection, and MRSA. Medical orders included daily flushing of the PICC line, administration of thrombolytic agents for de-clotting, and IV antibiotics. However, there were no orders in place to monitor the PICC line for infection, change the dressing, or flush the line before and after medication administration, as required by facility policy. The care plan only included monitoring for infection and leaking, with no interventions for routine PICC line care. Review of the medication administration record showed that the prescribed thrombolytic agent was not administered, and progress notes documented missed antibiotic doses due to PICC line occlusion. There was also no documentation regarding when the PICC line was replaced or discontinued. The DON confirmed the absence of necessary orders for PICC maintenance and flushing after medication administration. Facility policies required regular flushing and dressing changes for central venous catheters, but these were not followed for the resident in question.