A resident receiving TPN through a PICC line had a soiled dressing that had not been changed for about 2 weeks. The RN confirmed PICC dressings are changed weekly, and the DON stated they should be changed weekly and as needed to keep the site clean, dry, and intact. Facility policy required central line dressing changes at least weekly or sooner if moist, loosened, or soiled.
A resident receiving IV antibiotics through a PICC line had a transparent dressing that was not dated and was peeling at the edges, and the resident stated it needed to be changed. Staff documentation showed dressing changes were recorded, but there was no documentation of arm circumference measurements, and staff interviews indicated the RN did not measure the arm and the care plan for IV antibiotics was not in place. The facility’s policy required sterile PICC dressing changes and labeling of the dressing with date, time, and initials.
A resident with a PICC line had a clear dressing that was rolled up at the edges and dated well beyond the 7-day change interval. The DON confirmed PICC dressings are to be changed every 7 days, but there were no active PICC orders on the physician order sheet, no PICC care documented on the MAR, and the resident said no one had touched the PICC site for a while.
A resident admitted with multiple serious conditions, including infective endocarditis, had orders for IV antibiotics to be administered via a PICC line but no corresponding orders for PICC care, such as flushing or dressing changes. Staff, including an RN and the DON, stated that PICC care is usually done routinely and included in batch admission orders, but acknowledged that these orders were not entered for this resident, resulting in IV therapy being provided without documented PICC line maintenance orders.
Improper Maintenance of PICC Line Dressing: A resident with a single-lumen PICC receiving IV antibiotics had a transparent dressing over the insertion site that was bubbled, not secured to the skin, and had dried brown substance underneath it. The RN was responsible for the dressing, but the TAR and physician order did not align with the observed condition, and the DON stated the dressing should have been changed when the soiling was noted.
A resident with an IV midline had a transparent sterile dressing that remained dated far beyond the weekly change interval ordered by the physician, reflected in the care plan, and stated in facility policy. Staff gave inconsistent answers about how often IV dressings were changed, while the MAR documented the weekly dressing change as completed even though the dressing observed on the resident was dated much earlier.
An LPN without required IV certification administered ordered IV Vancomycin to a resident with multiple complex conditions, including UTI, sepsis, CHF, kidney failure, vascular dementia, and type 2 DM with circulatory complications. The resident’s EMR and MAR showed IV Vancomycin doses given, and the MAR contained the LPN’s initials for one of the administrations. The LPN acknowledged not being certified to give IV antibiotics but confirmed having administered them, and the ADON verified that IV certification is required for LPNs to infuse IV antibiotics and that this LPN was not on the facility’s list of IV-certified LPNs.
A resident with a care plan for IV hydration therapy received D5 IV fluids based on a physician order and MAR entry that lacked a prescribed infusion rate. Nursing staff documented that IV fluids were infusing and continuously running but did not record the rate, and during interviews an RN referenced a “normal” rate used at the facility while being unable to recall the actual amount given. The DON could not provide documentation that the order had been clarified, and an LPN who administered the IV fluids was unsure of the exact order, did not recall clarifying the missing rate with the physician, and reported no awareness of standing IV orders, despite facility policy requiring complete medication orders including route, dose, time, and frequency.
IV Antibiotic Infused Too Quickly During Pump Setup: An RN started an IV ampicillin infusion for a resident with a PICC line and attempted to attach the tubing to the pump after connecting it to the resident. The white clamp opened during setup, allowing the antibiotic to flow freely, and about 20-30 mL infused in less than a minute instead of over 60 minutes as labeled. The resident had a UTI, CKD, bladder cancer, dysphagia, and cognitive communication deficit.
Failure to perform hand hygiene and disinfect a PICC access device occurred when the DON entered a resident’s room, donned gloves without cleaning her hands, stopped an IV pump alarm, and flushed the resident’s PICC with saline and heparin without sanitizing the needleless access device. She then removed her gloves and left without sanitizing her hands. The DON stated hand hygiene should be done before gloves and the access device should be disinfected before flushing the PICC.
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