Hello all....
I am part of a "new" Vascular Access Team and am revising policy/procedures......looking for guidance/input.
1. How is tip location being phrased (At or #cm above/below SVC/RA jx...distal 1/3 of SVC....etc) and how do policies read as far as when the line is ok to use? I have read the 2008 research article by Baskin, which looked promising as far as easily identifiable/consistent anatomical landmarks - verified by CT, but is primarily on adolescents. How have people resolved issues with continuity between radiologists?
2. Do PICC team nurses "release line for use" after CXR report or do you require a MD order?
Thank you in advance!
Keely Ralston, RN-BC, RCIS
These are some controversial issues. A chest xray is never going to provide very accurate data on where the tip is locations in relationship to the cavo-atrial junction. This CAJ is on the posterior side of the heart and is not seen directly on a chest xray. You will need to rely on measurements such as right tracheobronchial angle plus 5 cm. Many radiologists will say it is acceptable if it is right TB angle plus 5 cm, above or below by 2 cm. Some use carina for the landmark as the right TB angle is hard to see on some patients. The carina is the middle where the right and left bronchi divide. These controversies are why ECG based tip location is much more accurate than an xray.
As for the idea of "releasing" a PICC - this has never made any sense to me. If you policy states the tip location and the catheter is determined to be within that area, then the catheter can be used for infusion. Simple as that. I do not understand the need for requiring an LIP order to then use the PICC for infusion. So yes, in my experience, the nurse inserting the catheter assesses the xray for proper tip location (please note that you are NOT reading the xray) and then begins the use of it for infusion.
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