Forum topic

We are using ECG guidance for PICC tip placement.  It has been a great success.  Many doctors are excited that their patients are getting less radiation and the nurses love that we walk out of the room and say, "your PICC is ready to use".  We are inserting PICCs with less pull back now, so we are getting done faster.  In June 2012 the doctors on the Clinical Performance Committee approved its use as we had provided 2 months of data with follow up CXR that the tips were appropriately placed (as best as some CXRs can show).  We are still watching as we have patients that will get a CXR for other reasons.  This is approved only for patients with an identifiable p-wave. 

We print the ECG comparison produced by our equipment showing the patient's baseline ECG and the maximum p-wave achieved.  This is then put in the chart in the ECG section for documentation.  Your facility needs to decide how much proof they want of tip placement.  Do you usually get a copy of the CXR report?  If not then you shouldn't need the ECG report.  If you do usually get the CXR report then ask for the ECG confirmation record from whereever/whoever placed the PICC.

Mary Penn RN 

 I would not accept a patient in any type of setting without documentation of where the PICC tip was originally located. Previous to ECG, this was a report of the chest xray done post PICC insertion. Now that ECG is being used, I think it is encumbent upon the hospital and the alternative site to work together on this issue, but I do think the home care should be asking for some ECG information upon PICC placement. With that being said, secondary tip malposition, aka tip migration, can happen at any time and all nurses need to know the signs and symptoms of this type of malposition. See INS SOP on Malposition. Lynn