Our policy and guidelines tell us to rule out catheter malposition/migration when the external measurement of the central catheter has increased by >2cm. Is there an INS standard that supports using 2 cm as the measurement to use as a guideline?
Our policy and guidelines tell us to rule out catheter malposition/migration when the external measurement of the central catheter has increased by >2cm. Is there an INS standard that supports using 2 cm as the measurement to use as a guideline?
No, a specific change in the external catheter length is not included in the INS standards of practice because there is no specific evidence for such a recommendation. See SOP 53 CVAD Malposition. I think you are talking about catheter displacement or dislodgment. Secondary malposition, aka tip migration, is the tip only moving after it has been placed in the correct location, however the external length has not changed. A tip correctly placed at the CAJ that has been displaced by only 2 cm may not require any action depending upon what is being infused. The SVC is about 7 cm long, so this 2 cm change could mean that the tip is still in the lower third of the SVC. If only ABX is infusing for several more days, there would probably be no issue. On the other hand, a catheter tip left in the lower SVC, not at CAJ that has been displaced by 2 cm may now be in the middle SVC and be at a greater risk for tip migration to the IJ or other veins. In my opinion, there can not be strict rules about this as it requires a patient assessment of the original tip location, how much was displaced, what was infusing, and the length of therapy remaining. 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