Incomplete Orders and Care for Midline Catheter
Penalty
Summary
The facility failed to provide adequate treatment and care for a resident’s midline catheter by not ensuring complete and appropriate physician orders for its use and maintenance. Facility policy on Midline Catheter Care and Maintenance, last reviewed 1/27/26, required that midline catheters be flushed with 10 cc normal saline after each intermittent infusion, after discontinuing a continuous IV, or every shift when not in use, and specified that only RNs and LPNs with approved IV certification could perform midline care. The resident, who had diagnoses including hypertension, diabetes, and a left tibia fracture, was admitted on a specified date and later had a nursing progress note indicating that an IV infusion company was notified for midline placement. Subsequent physician orders for this resident’s IV therapy directed cefazolin sodium 2 grams IV every 8 hours for a wound infection for 7 days but did not include the type of IV access, instructions for flushing the IV, dressing change frequency, or changing the IV end cap. A nursing progress note documented that the resident was tolerating the IV and that the midline was flushing easily, but there were no corresponding detailed orders addressing midline care. In an interview, the Director of Nursing confirmed that the physician orders lacked these essential components and acknowledged that the facility failed to provide adequate treatment and care for the midline catheter for this resident.
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