When starting to use 3CG (ECG) technology for PICC tip confirmation, for how many patients is it recommended to also get a chest x-ray so it can be demonstrated that the ECG method works as expected?
I have never seen a recommendation for a specific number of needed xrays to prove that they can be routinely eliminated. As we see more and more published studies, this will become a mute point as a hospital will not requre this "testing" period. we will have published evidence for use. Currently, there are studies from Europe on ECG for placement of all CVADs. So this question should be addressed by your risk management and be based on the comfort level of the "powers that be" in your organization. Chest xray can never to totally eliminated as there will always be patients with cardiac anomalies that do not have a discernable P wave. Lynn
Our radiologists wanted 5 lines to confirm the technology was being used correctly and for everyone to feel comfortable. Our biggest hurdle was changing policy to include 3cg for acceptable tip clearance. Then we had to have everyone's signature on the policy. The paperwork took a lot of time.
Tip confirmation technology efficacy is very well documented in the literature. The technologies on the market are all FDA approved and many are using them across the country successfully. Problems can occur when it relies solely on interpretation of the inserter. The educator should work with you and your radiology department so that all feel comfortable with the technology, when in doubt get a CXR discuss the case about why there was doubt .
Our policy was VERY generic it states that the CVAD can be used after tip confirmation by a radiologist or FDA approved tip confirmation technology in the lower one third of the SVC/CAJ. This way if contracts change or better technologies are developed the policy doesn't need to be changed again.
I have never seen a recommendation for a specific number of needed xrays to prove that they can be routinely eliminated. As we see more and more published studies, this will become a mute point as a hospital will not requre this "testing" period. we will have published evidence for use. Currently, there are studies from Europe on ECG for placement of all CVADs. So this question should be addressed by your risk management and be based on the comfort level of the "powers that be" in your organization. Chest xray can never to totally eliminated as there will always be patients with cardiac anomalies that do not have a discernable P wave. 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
Our radiologists wanted 5 lines to confirm the technology was being used correctly and for everyone to feel comfortable. Our biggest hurdle was changing policy to include 3cg for acceptable tip clearance. Then we had to have everyone's signature on the policy. The paperwork took a lot of time.
Tip confirmation technology efficacy is very well documented in the literature. The technologies on the market are all FDA approved and many are using them across the country successfully. Problems can occur when it relies solely on interpretation of the inserter. The educator should work with you and your radiology department so that all feel comfortable with the technology, when in doubt get a CXR discuss the case about why there was doubt .
Our policy was VERY generic it states that the CVAD can be used after tip confirmation by a radiologist or FDA approved tip confirmation technology in the lower one third of the SVC/CAJ. This way if contracts change or better technologies are developed the policy doesn't need to be changed again.