Failure to Assess, Use, and Timely Remove Unused Peripheral IV Catheter
Penalty
Summary
The deficiency involves the facility’s failure to provide adequate treatment and care for a peripheral intravenous catheter (PIVC) in accordance with professional standards and its own policy for one resident. A resident with no cognitive impairment, who required supervision/touching assistance for most ADLs and transfers, experienced nausea and vomiting and had an order for placement of a PIVC for hydration. Provider orders directed staff to administer 0.9% sodium chloride at 100 mL/hr every shift for one day, totaling one liter of normal saline, starting late on the day the PIVC was placed and discontinuing the following morning. The Medication Administration Record showed that the ordered IV fluids were never administered. A nurse practitioner note documented that the PIVC was available in case of need but was not currently being used, and there were no further evaluations, assessments, or notes supporting the ongoing need for the PIVC after that. The facility’s policy required staff to evaluate the continued need for vascular access during provider visits and care planning, to remove a peripheral IV if it was not used for more than 24 hours or no longer clinically indicated, and to document the date and time of removal and resident tolerance. According to the resident’s interview and the Assistant DON’s investigation, the PIVC, which the resident reported was never used, remained in place for several days and was not removed until four days after insertion, despite the IV fluid order having been discontinued the day after it was written. Clinical record review revealed no documentation of removal of the PIVC and no documentation of assessment of the catheter or the skin surrounding the IV site. In an interview, the Assistant DON confirmed that the PIVC was not removed until several days after insertion and acknowledged that facility policy should have been followed.
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