Hello. I am new to this forum, but have been placing picc's for about 11 years. I need some references from articles that support the national standard that picc's be placed in the distal 1/3rd of the SVC. I have moved recently and can't seem to find the data that supports this standard of practice. Can anyone out there direct me to some links to support this? I have a cardiologist that is challenging the way we measure for picc placement and feels that we should be shaving off some of our length and placing our tips at the level of the corina ( ?spelling).  He states that when he does TEE's , he if finding about 50 % of the patients with picc's significantly in the right atrium when cxr reports not. I explained that ideally we strive to place them at the junction of the SVC and RA and explained why.  Any information out there would be much appreciated. Thanks!Â
There are several articles discussing recommended tip location and there are also several studies that document the fact that PICC tips do tend to move inward. Look for articles by Tom Vesely such as
1. Vesely T. Central venous catheter tip position: A continuing controversy. Journal of Vascular and Interventional Radiology. 2003;14:527-534.
2. Vesely T. Optimal positioning of central venous catheters. Journal of Vascular Access Devices. 2002;7(3):9-12.
Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Should we then reconsider where we our tip placement to be? Or when measuring, should the arm be as close to the body as possible to get a more accurate measurement? Not sure it would make a difference.
Also, the initial one shot cxr for tip placement may indicate tip placement in good position, but subsequent cxr's for whatever reason may show that's not the case with tips being deeper. I heard from a radiologist that if the film happens to be shot when the right atrium contracts, the tip if in the atrium, may become blurred and not seen.
Laura McRae, RN, BSN, CRNI