Lynn, any idea about how the INS Standards will address this in the new Standards coming in 2016? I am in the midst of converging a PICC policy among sites in our system nationwide and there is a wide variety of practice. Some sites xray all patients with PICCs who are seen in the ED or are admitted with PICCs in place; some sites only xray patients whose PICC was placed elsewhere; some sites check a blood return and external visible length. I know you have said you want to know where that tip is before you use it. Will the standards offer us something more definitive than expert opinion (not that that isn't helpful!)
Thanks - Wendy
The standards are out now for review, so the content has not been finalized. That means I don't know what it will say. I can tell you that there are a lot of studies and articles about catheter malposition, divided into primary (occuring on insertion) and secondary (occuring during dwell). Another way to categorize is intravascular malposition and extravascular malposistion. There are no studies, reports, or how to articles of any kind discussing or even suggesting a chest xray on admission when the patient has any type of CVAD. Sorry I can't be more specific. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Patients coming from other institutions should have a chest film because of the onerous practice of cutting PICCs down to midline length. Externally, it looks like a PICC and people will think that it is, but this is an accident waiting to happen, IMHO.