I have been seeing more and more PICC tips and tunneled catheter tips where the tip location is in the right atrium. The Physicians inserting these catheters refuse to pull these lines back. Is this an acceptable tip location as long as patient doesnt develop cardiac symptoms? Is the right atrium going to be the new recommended location for PICC and tunneled catheters?
Jean Cancelmo Cahall, BSN, CRNI
South Jersey
This is definitely not a new issue as we have been debating it for at least 20 years. The recommended tip location is the cavoatrial junction or the lower segment of the SVC near the junction with the right atrium. There is no evidence to support the safety of and CVAD tip located deep inside the right atrium. All recommendations from manufacturers instructions for use and numerous medical and nursing organizations state cavoatrial junction. I think I can safely say that the right atrium will not be the new recommendation for the tip location for any CVAD. So you have to work in a collaborative manner with your physicians 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
My first thought was there must be new ecg tip confirmation technology in your area. How do you know the tips are in the right atrium? Are these lines intentionally placed and documented in the right atrium? Are you seeing them in chest xrays? Are you getting more and more ecg tip confirmed lines vs cxr confirmations? The ecg confirmed lines might be deeper than you are accustomed to seeing. Just throwing that out there.
ECG technology is only available in the USA for PICCs. The original question included tunneled caths as well, which do not have ECG technology and are inserted in a surgical setting usually under fluroscopy. so I believe the question is referring to intentional tip locations within the RA. This is an old debate for sure. 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
Some PICC tips that are located in RA by chest x-ray and they are not being pulled back. Some tunneled catheters being placed by MD's are in the RA. The PICC tips confirmed by ECG are always in SVC. When the tips are in RA, it doesn't say if proximal or distal RA. Is it ok to accept a patient for Home Infusion if a tip is in RA and pt is not having any s/s of cardiac symptoms??
Your management must make this decision. Use the INS Standards #32, 33, and 35 along with the references for each. Take it to the apprpriate committee within your organization for a collaborative decision. Your organization must establish a policy and everyone must be following that same policy and procedure. 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