Is there any evidence based literature/info on where Picc Tip should be for home IV abx. therapy? I have come across physicians that have Picc lines placed for home IV abx. therapy (continuous & intermittent) and say it does not matter where the end of the catheter tip is at. Recently had a line that was orginally in the right neck per cxr....then retracted to the brachiocephalic / near the edge of the right internal jugular vein & per physician...say it was okay to d/c home w/ IV abx. therapy.
Does it depend on the type, concentration / osmolarity of the Antibiotic on whether the line "needs" to be in the svc / cavoatrial junction?
Please consider the article noted below... A story of what can happen with a line placed in a sub optimal position . This unfortunate patient experienced a tradgic outcome . The potential is there... one never knows.
Authors - Ann Zonderman and Nancy Moureau The patient was receiving Rocephin.
JAVA Spring 2007 - Complications of Vascular Access Device Terminal Tip Placement: A Case Study and Review of Subsequent Legal Action
Ann Zonderman, BSN, JD, CRNI
CVAD tip location does not depend on any factors related to the infusate. In other words, you can not place a catheter high in the SVC or in the IJ as long as the pH or osmolarity is XX. The national standard is all CVAD tip locations should be in the lower third of the SVC near the junction with the right atrium. I would refuse to infuse anything, even injection normal saline, through any catheter infusing retrograde into the IJ or contralateral subclavian veins. Also we know that catheter placed in the upper portion of the SVC has much greater rates of tip migration or secondary malpositon and thrombosis. So you must find ways to educate these physicians about correct tip locations and refuse to put patients at risk for serious complications. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you Ann & Lynn. I did speak w/ the Resident physician and had my Picc catheter tip position statements & articles to reference w/ me, along w/ Lynn's previous address re: cath. tip placement. Ultimately, the Picc was exchanged & pt. was dc'd home w/ a Picc tip in the lower 3rd svc. However, what I have had to battle almost constantly are Physicians who think a Picc placed IS good enough to send home, whether it is in the subaxillo, subclavian, brachiocephalic veins. They are NOT midline and NOT in the lower 3rd svc. But because the Physician deems the medication does not need a "Central" line, ANY tip position is adequate for home abx. infusion. Ugh!!!! It's a hard battle to fight!!
Thank you Ann & Lynn. I did speak w/ the Resident physician and had my Picc catheter tip position statements & articles to reference w/ me, along w/ Lynn's previous address re: cath. tip placement. Ultimately, the Picc was exchanged & pt. was dc'd home w/ a Picc tip in the lower 3rd svc. However, what I have had to battle almost constantly are Physicians who think a Picc placed IS good enough to send home, whether it is in the subaxillo, subclavian, brachiocephalic veins. They are NOT midline and NOT in the lower 3rd svc. But because the Physician deems the medication does not need a "Central" line, ANY tip position is adequate for home abx. infusion. Ugh!!!! It's a hard battle to fight!!
This will require continued education of your physicians. You will need to have a strong command of anatomy and physiology knowledge, along with the pharmacology issues of pH and osmolarity and the damage it can do when the catheter tip is not properly placed. The physicians are wrong - any tip location is just not adequate. So keep up your struggle to continue this education and, most of all, to act as a patient advocate for safe patient care. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861