Having a discussion with coworkers and managers on weather you get a chext xray to confirm placement of tip before instilling cathflo when you have occluded or no blood return on picc or port. Our policy was that you need a chest xray to make sure it is still in SVC, if no blood return or total occluded before instilling anything into it. Is there any specific website or journal on doing or not doing a chest xray prior to instilling cathflo?
I do not have a journal reference, however, if the line has been functioning without a problem and you can associate the malfunction with a recent occurrence such as a blood draw or other associated history than I would feel comfortable proceeding with the tPA without a CXR. History is vitally important as is a careful assessment of the line itself..i.e. is the noncoring needle dislodged, is there pain, edema, redness, etc at port site or along vein path. Every occlusion should be evaluated independently.
I agree with Angela's post. The history of what led up to the problem is so critical in determining the clinical course of action. I do not recall ever seeing any evidence to support a chest xray or not before tPA. If the patient is complaining of hearing a running stream or gurgling sound, this indicates the tip is angled upward in the IJ and a chest xray may be needed. But without a chest xray, what are the risk of instilling tPA when the tip is not in the SVC? I can't really think of any so it would be a matter of the costs for each alternative. I would recommend a literature search to find what information you can, contacting Genentech for their input, then taking all of this to a decision-making committee to create a policy about this issue. 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