So I went to review my system's 2014 CVC policy and give my opinions and recommendations. It delineates CVCs, PICCs, Midlines, and. ..... Midclaviculars! This was not in the 2011 policy. ARGH! I searched this and other forums on the midclavicular topic, but am not finding much current research to support my position (after 2007). I have been asked to provide more current articles for tip location to substantiate my position opposing these lines. Can anyone point me towards current research/evidence supporting not using the midclavicular tip location? I've already tried the INS standards, AVA position paper, and older evidence, but it is not current enough. ARGH, again!
Thank you!
Kathleen
I am not aware of any new studies. That question was answered by the research you have found. The need for research is so great that these types of questions are usually not repeated in lots of duplicate studies. The INS Standards of Practice have never recognized the midclavicular tip location as an acceptable one due to the lack of evidence to support positive outcomes. In my opinion, a system that demands research less than 5 years old is only throwing up smokescreens to maintain the current status. 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
The INS position paper has more recent dates. If they are hung-up on dates.
www.ins1.org/files/public/09_28_09_PICC_tip_position_paper_final_NEW.pdf
REFERENCES
1. Corrigan A. Infusion nursing as a specialty. In: Alexander M, Corrigan A, Gorski L,
Hankins J, Perucca R, eds.
Infusion Nursing: An Evidence-Based Approach. 3rd ed. St.Infusion Nursing: An Evidence-Based Approach. 3rd ed. St.J Infus Nurs.
2006;29(1S):S42.
4. Harako M, Nguyen T, Cohen A. Optimizing the patient positioning for PICC line tip
determination.
5. Earhart A, Royer T. Taking the leap from PICC placement to tip placement.
Emerg Radiol. 2004;10:186-189.JAVA.2007;12(3):148-155.
6. Miller C. Infusion nursing practice. In: Alexander M, Corrigan A, Gorski L, Hankins J,
Perucca R, eds.
Saunders/Elsevier; 2010:488.
Infusion Nursing: An Evidence-Based Approach. 3rd ed. St. Louis, MO:Louis, MO: Saunders/Elsevier; 2010:4,5.
2. Hadaway L. Infusion therapy equipment. In: Alexander M, Corrigan A, Gorski L,
Hankins J, Perucca R, eds.
Louis, MO: Saunders/Elsevier; 2010:425.
3. Infusion Nurses Society: Infusion Nursing Standards of Practice.
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.
Just to help show why not to do midclavicular placement, please see
• Complications of Vascular Access Device Terminal Tip Placement, Journal of Association of Vascular Access, Spring, 2007. Moureau, Zonderman
Verdict against a hospital $7 million
Ann Zonderman, BSN, JD, CRNI