Centerwell Home Health

“In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This Element is not met as evidenced by: Based on observation, record review and interview the facility failed to provide in accordance with current clinical practice guidelines and accepted professional standards of practice Intravenous Therapy for 2 of 2 patients observed (Patient#1 and Patient #10 ) by not checking patency of Peripherally Inserted Central Catheter (PICC) line prior to flushing and drawing blood for laboratory samples and 1 of 2 patients (Patient #1) for not purging extension line of air prior to attaching extension line to PICC line and flushing PICC line with 10 milliliters (ml) of normal saline (NS) (double lumen ports) two separate extension ports. Findings include: Review of Patient #1’s clinical record documented Patient #1 was admitted on 9/7/2024 with diagnoses including Sepsis [ infection in the blood]. Review of Patient #1’sphysician orders dated 9/7/2024 read “Skilled nurse to collect blood specimen …via PICC and report to physician [Physician name]. Review of Patient #1’s visit note report dated 1/15/2025 read “SN [skilled nurse] removed old PICC line dressing from RUE [right upper extremity]and discarded in trash. Using sterile technique, SN [skilled nurse] cleansed around PICC site with Alcohol and chloral-prep swab stick and allowed to dry, applied new stat lock and bio-patch. Patient tolerated well” Review of Patient #1’s Client Coordination note report dated 1/15/2025 read “Late entry visit done 1.14.25 Patient has PICC line to RUE, Double lumen SN obtain lab from PICC line right upper extremity, accessed red port line. Alcohol wipe injection cap. Flushed with 5cc [cubic centimeter also known as ml] of NSS [normal saline solution], wasted 5cc of mixed blood, discarded in biohazard container. SN flushed PICC line with 20ml, SN changed extensions, and injection cap… “ During an observation on 1/14/2025 at 09:22 AM Staff A, License Practical Nurse (LPN) observed to clean double lumen ports and flush Patient #1’s (PICC) double lumen ports. Blue tip port and red tip port (double lumen -2 ports) with 10 ml of NS without aspirating blood back into the syringe to confirm a free flow of blood return prior to flushing. 10 ml blood obtained, wasted and an additional 10 ml blood obtained via syringe for laboratory testing and the PICC line flushed with 10ml NS. During an observation on 1/14/2025 at 10:35 AM Staff A, LPN observed removing extension tubing from sealed package and attaching extension tubing on PICC double ports, a red port and blue port, without out flushing the extension tubing to evacuate the air and no aspiration of blood into the extension port prior to flushing double lumen PICC ports with 10 ml NS solution. During an interview on 1/14/2025 at 10:42 AM with Staff A, LPN stated “No, we do not aspirate blood prior to flushing we just flush the PICC. “I did not flush the extension lines prior to attaching to the PICC ports and flushing, I missed that step. The extension lines should be flushed prior to attaching to the patient to evacuate all the air in the line. Then the lines should be attached to the patients PICC line and flushed.” During an interview on 1/15/2025 at 12:55 PM with Staff B, LPN stated “prior to using a PICC line the line has to be checked for patency by aspiration of blood prior to flushing the PICC line. All tubing must be primed prior to attaching to PICC line and prior to flushing ports. Lines are always checked by aspiration of blood for patency prior to flushing with NS”. Review of Patient #10’s Clinical Record documented Patient #10 was admitted 1/11/2025 with the diagnosis Acute osteomyelitis, right ankle and foot”. Review of Patient #10’s physician orders dated 1/13/2025 read “Skilled nurse to collect blood specimen …2 x a week through 2/20/25 via PICC line or venipuncture and report to doctor… “Blood draws…Flush line with NS 10ml, obtain 10ml of blood for discard, flush lumen with 10ml .9% and 5ml of heparin flush after blood draw”. During an observation on 1/16/2025 at 08:15AM with Staff D, observed to clean port with alcohol pad and attach 10ml NS syringe to port, flushed without aspiration of blood prior to flush to check for placement. Withdrew 10 ml blood product and wasted prior to attaching Vacutainer (devise used to obtain blood) and retrieved 2 vials of blood. Port flushed with 10ml NS syringe and then antibiotics initiated. During an interview on 1/16/2025 at 08:22 AM with Staff D, RN stated “I do not normally aspirate sometimes I do. I just flush the line with NS” During an interview on 1/14/2025 at 3:06 PM with Staff C, Registered Nurse Clinical Manager stated “The expectation is that blood is aspirated to check for patency prior to flushing the line. The Intravenous line must be purged of air prior to flushing”. During an interview on 1/14/2025 at 4:00 PM with the Director of Nursing/Administrator stated, “extension tubing, any tubing should be flushed prior to attaching to the patient’s’ PICC and aspiration of blood in the line prior to flushing to check the line for patency. Review of facilities policy and procedure dated 7/2024 titled “Peripherally inserted central catheter (PICC) flushing and locking, home care”. Read “Maintenance of peripherally inserted central catheters (PICC) in the home care setting is necessary to provide timely and therapeutic infusion that are required by patients. PICCs are used in the home care setting to administer medications blood products, chemotherapy, IV fluids, and parenteral nutrition. Aspirating for a blood return and flushing a PICC are routine steps for assessing catheter patency before use. Flushing also prevents mixing incompatible medication and solutions after infusion and catheter occlusion after blood sampling... Review of facilities policy and procedure dated 7/2024 titled “Infusion Therapy Requirements and Guidelines” read “…Section 1… Skills competency should be documented at least annually” … Section 2: Infusion Therapy Practice Clinical Competency…flushing procedure for vascular access devices… Review of facilities procedure (Based on Springhouse recommendation) Aspirating for a blood return and flushing a PICC are routine steps for assessing catheter patency before use. Flushing also prevents mixing incompatible medication and solutions after infusion and catheter occlusion after blood sampling...” Review of the internet website page titled “Peripherally inserted Central Catheters (PICCs): Best Practice dated September 7, 2022, read … Prior to using a PICC, it should always be checked for patency. This is done by gently drawing back on the syringe and confirming of a swift blood aspirate. If blood aspiration is not possible, or is sluggish, a small amount of saline can be instilled (Denton, 2016; Gorski, 2021). The use of saline at this stage will not cause the patient harm. Gorski et al. (2021) also suggests that a small barrel syringe can be used to attempt blood aspirate. The use of a small syringe will exert less negative pressure and might improve the success...””