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mamirhekmat
Picc tip in R atrium

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

Gwen Irwin
I don't believe there is any

I don't believe there is any evidence that indicates the right atrium as the appropriate location.

Gwen Irwin

Austin, Texas

Craig Farris RN CRNI
I just looked up on the

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

lynncrni
All catheter manufacturers,

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

momdogz
Central Venous Catheter Tip

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 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

fpiedmont77
SVC or Cavo-atrial Junction
SVC or Cavo-atrial Junction it is!!! No more than that.
htshapiro
I was told in a PICC tip
I was told in a PICC tip verification class that because of the size of a PICC catheter, place ment in the RA can cause it to vibrate producing the problems that Lynn described.  HD catheters and Central lines often don't cause this problem because of their lumen size and stiffness of the catheter.
lynncrni
I am not quite sure what you

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

KATHLEENT.MOHN
kathy mohn-las vegas- You

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

coffeemania
Watch out!!! DO NOT have the
Watch out!!! DO NOT have the tip in RA. This is my experience. It will get you!!! Really really bad!!! Good luck.
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