LVN Removed PICC Line Outside Scope of Practice
Penalty
Summary
The deficiency involves the facility’s failure to ensure that licensed nurses possessed and adhered to the appropriate competencies and scope of practice for resident care, specifically related to the removal of a Peripherally Inserted Central Catheter (PICC) line. A male resident with chronic systolic congestive heart failure, chronic atrial fibrillation, ischemic cardiomyopathy with pacemaker, venous insufficiency, and a history of pulmonary thromboembolism was admitted and had an active care plan for completion of an antibiotic regimen via PICC line. The resident’s MDS showed moderate cognitive impairment with a BIMS score of 11. The care plan documented the use of a PICC line for antibiotic therapy, and the resident later reported that his PICC line had been removed at the facility a couple of weeks prior to the survey. On the date of the incident, a progress note completed by an LVN documented that the resident’s midline was discontinued per MD order using aseptic technique, with the catheter measured, tip intact, pressure applied, and a pressure dressing placed. The LVN documented that the resident tolerated the procedure well and was resting comfortably afterward. During interview, the resident confirmed that he had a PICC line that was removed at the facility, did not recall who was present during the removal, and denied pain or discomfort during or after the procedure. Observation of the site by surveyors showed no swelling, signs of infection, redness, or scabbing at the extraction site. Interviews with staff established that the LVN removed the PICC line independently, without RN presence or oversight, despite acknowledging that LVNs at the facility were only allowed to change PICC dressings and that PICC removal was not within LVN scope of practice. The LVN stated that RNs were responsible for pulling PICC lines and that removal required a provider order. The RN, ADON, DON, and Administrator each stated that only an RN could remove a PICC line per facility policy and Texas Board of Nursing standards, and that LVNs were not allowed to remove PICC lines. The ADON reported learning of the incident by reviewing progress notes and confirmed that the LVN had removed the line under discontinue orders from the NP, with no RN present. The DON confirmed she became aware that the LVN had removed the PICC line and informed the LVN that this was outside LVN scope of practice. Review of the Texas Board of Nursing position statement showed that insertion and removal of PICC lines or midline catheters is beyond the scope of practice for LVNs, confirming that the LVN practiced outside her scope when she removed the resident’s PICC line.
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