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BJ CRNI
Vertebral Body Units to indicate CVC tip position

I recently read a PICC insertion report that stated the following:

"Catheter tip position: Central. The tip is 2.5 vertebral body units (VBU) below the carina."

Has anyone seen this documentation of tip location in their practice to indicate it is in the CAJ? 

lynncrni
Yes, used mainly in infants.

Yes, used mainly in infants. I have never seen it used in adults. The carina and tracheobronchial angle angle are also used but none can ever be as accurate as ECG. 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

BJ CRNI
Thanks, Lynn. This

Thanks, Lynn. This documentation in the EMR was on 57 year old and documented by a NP.  It also stated "catheter tip location was fluoroscopically verified" and "catheter may be used immediately". Would you feel comfortable that this tip is located in the CAJ?

BJ Emory, RN, CRNI
Director of Infusion
Personal Touch Home Care

lynncrni
Well, I don't recall seeing

Well, I don't recall seeing this used in adults and don't remember the distances and measurements. I don't think any xray measurement can confirm tip location at the CAJ. Xray is just not that specific. All rad reports I have ever seen has the radiologist documenting "in the region of the lower SVC" or something to that effect. They never state specifically at the CAJ. More than likely it is at least in the lower third of the SVC. I would ask the NP to share her resources on this measurement for adults. Also was the an AP or PA view chest xray. If AP view, the spine is closest to the film - was it a portable X-ray taken of patient in the bed? 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

BJ CRNI
No xray verification; it was

No xray verification; it was "verified fluoroscopically" and I was told the documentation had changed due to some "new reccomendations from the Society of Interventional Radiology". I have not found that information.  I checked on reimbursement documentation and criteria for central lines has not changed. 

BJ Emory, RN, CRNI
Director of Infusion
Personal Touch Home Care

lynncrni
Fluoro is a radilogical

Fluoro is a radilogical procedure but does not usually provide a final film to document the location unless the inserter takes a film. I am not aware of anything new from SIR. I would fully expect this inserter to provide this information to you. You should be following organization P&P and so should the inserter. If there is a change desired by the inseter it should be presented to the appropriate committee for assessment. You can do a literature search to see what is available or check SIR website. 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

BJ CRNI
Thanks again, Lynn. This is

Thanks again, Lynn. This is one of the challenges of home care and the information available to us from discharging hosptials.  We ask for the correct information, but it is not always what we want or ask for and we have no control over their organization's policy and procedure.

BJ Emory, RN, CRNI
Director of Infusion
Personal Touch Home Care

lynncrni
BJ, I ran across this study

BJ, I ran across this study today. Thought you might like to see it. It is a free download on vertebral bodies for CVAD tip location

https://academic.oup.com/bja/article-lookup/doi/10.1093/bja/aev218

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

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