I see that there are multiple discussions regarding x-raying lines on admission to verify tip placement prior to use. It seems the general concensus is to do so. We are a facility with multiple outpatient infusion settings. We have an inpatient policy to x-ray lines, however this is not followed in the outpatient infusion centers and our ED is questioning the need in their patients. What do other facilities do with their patients that have CVADs and come into outpatient settings to receive therapy. It seems unlikely they are x-rayed, although the rationale is the same for all patient populations.
Thanks,
Kristi Selck, RN
UF Health/Shands Hospital
Our infusions nurses look to see where the PICCs are placed. If the PICC was placed by our team they do not get a CXR unless it doesnt have a blood return. No blood return could indicate a spontaneous malposition.
If the patients PICC was placed in a nursing home or another organization a CXR must be done. There are still are out-source companies and inpatient teams that are trimming a PICCs to Midlines. For this reason your ED should also get a CXR so they know where the tip of the catheter resides. It could say PICC on the device but be a midline.
We just had this happen yesterday. Patient came in with a "PICC" in the upper arm. Family called it a PICC, patient called it a PICC admitting doctor even call it a PICC. Our staff nurse got a CXR, it was a midline.