Anyone have a recommendation of material I can provide to a radiologist who places PICC at a local hospital to support our need for confirmation that the PICC tip is in the lower third of the SCV? This physician questions 1) who states that this is the optimal position for the tip and 2) why we ask for documentation confirmation appropriate position. We have been seeing reports "in the central circulation" and "OK to use". I would like to respond to him as soon as possible. Thank you!
Instructions for use for each catheter comes in each package and states where the tip should be located. These statements have been cleared by the FDA and are the only things that the manufacturer can tell you about tip location. There are numerous medical studies that support tip location in the cavo-atrial junction and the higher rate of complications that occur when this tip location is not achieved. The Infusion Nursing Standards of Practice established what all nurses can/should/shall do or perform regarding all vascualr access and infusion therapy. Although the standards do not use the specific language that you mentioned, the standards do state that the nurse must document "confirmation of the anatomic location of the catheter tip for all CVADs prior to initial use". In order for nursing to meet this standard, simple statements like "OK to use" or "in good position" are not acceptable. I do realize that the radiologist can not state unequivocally that the CVAD tip is exactly in the SVC or CAJ, however they can give you information such as appears to be in the XXX position in the SVC or tip location is XX cm below the tracheobronchial angle or XXX cm below the carina. That is very possible, and easy for radiolgy to do. They just have to be willing to do it. 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
Thank you Lynn.....that is basically what I am going to provide this physician-the applicable INS standard and the section from "Infusion Nursing" pertaining to catheter tip confirmation. I believe that he is just requesting something to support our request for him to change the language of his report and provide more detailed description of the tip location. thanks again! Carol
Carol Sweeney, CRNI, Vice President of Nursing & Clinical Compliance ContinuumRx
There are many professional organizations in addtion to the FDA who state the optimal location for central catheters. In addition to the manufacturers instructions for use, the , INS, AVA, ONS, SIR all state the central catheters need to have their tips in the lower 1/3 of the SVC or Caval atrial junction.
All of these organization have supporting articles to back up thier recommendations. There are also many articles explaining the risks of a catheter who's tip is too high in the SVC. Many of those resources are here on this site, in the downloads section.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC