A resident with dementia, DM2, and chronic venous insufficiency had a PIV and IV medication orders, but the IV flush orders were discontinued while the catheter remained in place. The MAR and order summary showed no current flush orders, and an LPN stated he did not flush the IV because there were no physician orders. The DON verified the flush orders were discontinued and said the IV should have been discontinued at the same time.
PICC Line Dressing Not Changed Within Required Interval: A resident with a PICC line, severe sepsis, and septicemia had an IV dressing on the right arm that remained dated beyond the expected 7-day change interval while receiving IV vancomycin. The resident was unsure how often the dressing should be changed, and both an LVN and the DON stated PICC dressings are expected to be changed every 7 days or as needed if soiled.
A resident receiving IV antibiotics for a knee prosthesis infection had a PICC line dressing that was not changed on the ordered weekly schedule. The MAR showed dressing change entries, but observation found the dressing dated several days earlier, and the DON stated the dressing should be changed every 7 days and PRN if soiled. The facility guideline also stated transparent film dressings are changed weekly and PRN.
A resident receiving IV ceftriaxone through a central venous catheter had a dressing that remained dated from the catheter insertion date even though weekly sterile dressing changes were ordered. The assigned RN stated he did not change the dressing on the scheduled dates and only flushed the IV, while the chart showed the dressing as changed. The ADON and DON stated nurses were expected to follow the order and change central line dressings weekly using sterile technique.
PICC line orders and dressing care not documented: A resident receiving IV cefazolin through a PICC line had no physician orders for line flushes or dressing changes, and the dressing had no date on it when observed. Staff stated PICC lines should be flushed each shift and dressings changed weekly and as needed, but the orders were missing from the chart.
Improper Sterile Technique During PICC Dressing Change: A resident with a PICC in the R arm had a dressing change observed in which an RN placed sterile PICC dressing supplies on a clean disposable pad instead of a sterile drape/field before removing the existing dressing. Another nurse observed the error and stated it increased infection risk, and the RN later acknowledged she used the disposable pad instead of the sterile drape. The DON stated staff were expected to use a sterile drape for PICC dressing changes.
A resident with a PICC line for IV Cefepime had the line uncapped and dangling while an LVN prepared the medication, and the PICC tip contacted the resident's arm, side, and shirt before the tubing was attached without being cleaned again. The LVN also left part of the reconstituted Cefepime in the vial, so the resident did not receive the full ordered dose. The DON stated the vial should have been empty and the PICC tip should have been cleaned before connection.
Improper Syringe Size Used for Midline Heparin Flush: A resident receiving IV therapy for cellulitis, COPD, hypertensive heart disease, and hyperlipidemia had orders for midline SASH flushing and IV antibiotics. An LVN was observed flushing the midline and using Heparin lock flush in a 5 ml syringe, while another RN later used a 10 ml syringe. The DON and staff acknowledged that a 10 ml syringe should be used for PICC, midline, or central line flushing, consistent with facility policy.
A resident with a PICC line, diabetes, obesity, atrial fibrillation, and CHF had no documented PICC-related care plan interventions, and the PICC dressing was found stained, loosening, and dated well beyond the weekly change schedule. Although the MAR showed the dressing change as completed, staff interviews confirmed it was overdue and should have been changed sooner, with the DON acknowledging it was late and that loose or soiled dressings require more frequent attention.
PICC Dressing Not Changed as Ordered: A resident with chronic osteomyelitis was receiving IV piperacillin tazobactam through a PICC line, but the clear dressing remained dated from the hospital stay and no PICC dressing changes were documented in the MAR/TAR. The resident stated the dressing had not been changed since returning to the facility. Staff gave inconsistent answers about PICC care, while the DON said PICC dressings were to be changed every 7 days and that an order set should have been entered on admission.
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