Failure to Maintain Clean, Intact Midline IV Dressing and Use Proper Aseptic Technique
Penalty
Summary
The deficiency involves the facility’s failure to provide IV care and services consistent with standards of practice for a resident with a midline IV catheter. The resident had diagnoses including UTI and hypertension and physician orders for daily IV ertapenem, heparin flushes, and twice-daily monitoring for signs and symptoms of infection, pain, redness, infiltration, bruising, embolism, phlebitis, fluid overload, and electrolyte imbalance. The care plan and physician orders directed that the midline dressing be changed on a set weekly schedule, but did not include any PRN order for dressing changes when soiled. Documentation in the MAR/TAR and progress notes showed staff recorded the ordered clinical monitoring but lacked evidence that staff assessed or documented the midline dressing’s cleanliness or integrity. During observation, the resident was noted in bed with a single-lumen midline IV in the right upper arm, and the dressing was undated with a large amount of dried blood collected under the dressing and seeping through the soft cloth border. The bottom seal of the dressing was loose, while the top was reinforced, and this condition remained unchanged on subsequent observation. There was no documentation that staff had assessed or addressed the soiled and loose dressing from the time it was first observed through later surveyor observations. When a nurse prepared to administer the resident’s IV antibiotic, she performed initial hand hygiene and donned gloves and a gown, but then placed her gloved hand into her pocket to retrieve supplies, wiped the IV hub with an alcohol wipe, allowed the hub to rest back on the resident’s arm, and continued to handle the IV line, touch her hair, and remove items from her pocket multiple times without changing gloves. She then connected the IV tubing to the hub while still wearing the same contaminated gloves. The nurse acknowledged the dressing was soiled and loose and that there was no date on it, and stated she believed a PRN order was needed to change a soiled dressing. Another nurse later confirmed the dressing was scheduled only for weekly changes, verified the presence of dried blood and the need for a change, and confirmed there was no PRN order. Administrative nursing staff stated their expectations that IV sites and dressings be assessed daily, that midline dressings be changed multiple times weekly and as needed, and that nurses document site and dressing condition during medication administration, but the facility’s written policy addressed only peripheral IV catheter and site selection and did not address care and monitoring of the site and dressing.
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