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?
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, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
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
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, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
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
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, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
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
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, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861