At our hospital, our picc nurses are discussing the location of picc tips and what is the optimal tip location.  . As a rule, we have
been placing piccs in the lower svc/caj . Some of our nurses feel they should end up in the R atrium. I know that INS and AVA
recommends that they be put in the svc/caj but is there ,if any ,evidence that placing piccs in the R atrium is appropriate for picc
lines.
Maureen rn picc nurse
I don't believe there is any evidence that indicates the right atrium as the appropriate location.
Gwen Irwin
Austin, Texas
I just looked up on the Bard Web site Instructions for use on the Power PICC. It states that " this is not a right atrium catheter" To me placing it in the RA would be off label and against the manifactures recomendations. This could set you up for a huge liability. I recently had one go too long and into the RA and watched the return of the pts a fib before x-ray was even completed. good luck.
Craig
Craig Farris RN, CRNI
Clinical Nurse Educator
Craig Farris RN, CRNI
Clinical Nurse liaison
All catheter manufacturers, the FDA, standards and guidelines state the lower aspect of the SVC, near the cavoatrial junction is the preferred tip location for all CVCs. The only possible exception to this is a hemodialysis catheter. These statements are based on reported outcomes, however there is no large randomized clinical trial comparing the lower SVC vs RA tip location for any type of CVC. The concern over RA tip location is arrhythmias, cardiac erosion and tampanode. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Central Venous Catheter Tip Position: A Continuing Controversy
Thomas M. Vesely, MD
Journal of Vascular and Interventional Radiology 14:527-534 (2003)
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
I am not quite sure what you mean by "vibration". Cardiac muscle contraction brings the catheter into contact with the electrical system and heart wall, leading to arrhythmias and erosion. The stiffer the catheter, the greater the risk. So your theory would not seem to be evidence-based. Did the instructor produce the resources upon which this was based?
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
kathy mohn-las vegas-
You should also check what the State Board of Nursing has to say. In Nevada, we can't go any dieeper than the lower third of the SVC. Even our Doctors can't put Central Lines in the Atrium-by hospital policy.
kathy mohn-las vegas