How often should an implanted port be re-x -rayed for tip placement confirmation.
On our oncology unit patients with implanted ports come back in often and we do not re-Xray if they have a blood return, but our policy on all other CVADS that come in from home or another institution we make sure we get an xray either from the other hospital or our own to confirm.
Why the difference? An implanted port is a CVAD. Tip migration is a sporadic and intermittent problem, so there is no standard or guideline that recommends a specific frequency for repeat assessment of tip location. It is usually based on signs and symptoms of malposition. See 2016 INS STOP on CVAD Malposition. 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
We are revising our policy and looking at best practice when doing so. We use Lippincott as our procedure based reference. Prior to accessing an implanted port it states to verify tip location. It does not say "how to" verifty tip location. I will also post a separate question related to this as I'm assuming the lack of comments will continue.
Our current practice is to review in the medical record the tip location upon insertion and then the presence of a blood return upon accessing. If we do not have tip location of the device within our medical record we obtain from inserting facility OR get a chest xray to confirm location.
Does anyone use other methods of verifying tip location? Do you the product id card that the patient is given? This typically only states the type of port and when it was inserted but does not validate tip location.
I would agree with Lynn regarding the need for careful assessment for signs and symptoms of malposition. We used to get a CXR on patients who present to the ED or are admitted with a PICC already in place to verify tip location, but the lack of evidence to support this practice made us stop. We have our PICC nurses assess every PICC that comes in and if they have any concerns, they can order a CXR. Same thing for ports.
Wendy Erickson RN
Eau Claire WI
Agree with Wendy, we will obtain a CXR to verify tip locations if there is some sort of problem or concern.
Timothy McCrory, RN, VA-BC