Would anyone be willing to share their policy/medical directive for a protocol that does not routinely use a chest x-ray to verify tip position prior to the unblocking protocol for CVADs?
Melanie Cates
Nursing Practice Leader
Thunder Bay Regional Health Sciences Centre
Hi Melanie,
The new Occlusion Management Guidelines from CVAA do not call for a routine CXR to verify tip position prior to starting unblocking protocols. It states to consider radiographic study if change in external lenth, for internal kinking of catheter or potential pinch off syndrome. These guidlelines are available for free, if downloaded from their web site. I hope this helps.
Kerry McDonald RN
PICC Nurse,
Pembroke Regional Hospital
K. McDonald RN
I would challenge those Canadian guidelines. They have forgotten about the problem of catheter tip migration. There is no change in the external catheter length yet the catheter tip has moved to some other vein such as IJ, contralateral subclavian, or a small tributary vein. If the tip is in the IJ, the patient may complain of hearing a running or gurgling sound, but other tip locations do not produce such patient complaints. There is nothing that can be done at the bedside to assess for tip migration. Having the tip move to a smaller diameter vein with the tip positioned against the blood flow increases the risk of vein thrombosis. Your only clinical sign may be no blood return and resistance to flushing. You may not need to do a chest xray for each patient, but a nursing assessment of the entire situation, history of catheter functionality, type of infusates, etc should guide the decision. 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