Our facility policy has been to confirm tip placement when a patient transfers in with a PICC. We began using a tip locating system (VPS G4) almost two years ago with great success. We recently had one patient whose PICC was pulled back at another facility when they x-rayed for tip position. The pt. is a paraplegic with pressure wounds and x-ray obtained with pt laying flat, which can show tip to be deeper, possibly right atrium.
We just received a transfer with a PICC from another facility that uses 3CG. The floor nurse asked, do we confirm tip placement with x-ray? Hmmmmm.... if we have eliminated x-ray with these systems, do we then revert back to doing an x-ray on transfer if indeed it is well documented per the device to be lower SVC/CAJ? Do we then reposition the PICC if he x-ray (less accurate) shows the tip to be too low?
Thank you,
Terry
Forum topic
Fri, 11/07/2014 - 20:48
#1
PICC line placed with tip location system, then transferred to another facility
I don't think total elimination of all chest xrays is an achievable or desireable goal of the ECG technology. There will always be patients with cardiac arrthymias that prohibit the ECG from correctly identifying the p wave change. If your policy is to confirm tip location upon admission, which I think is a very reasonable approach, then your only options are to do a chest xray or set up the ECG system and advance the wire through the PICC. Which is the least invasive and most cost-efficient? If the external length has not changed yet the xray shows a questionably deep catheter that was originallly inserted with ECG and there is no evidence of arrhythmias, I would say it should not be withdrawn. The main purpose of the repeat chest xray would be to rule out jugular, contralateral subclavian or some other tip location due to secondary tip migration. 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
I knew I could count on you Lynn, thank you; your response is very reasonable and pratical.