Help!!! Our central line policy states the tips should be in the svc. It does not say cavo-atrail junction. I was OK with that for those situations where catheters cannot be placed exactly for some reason.... Meaning if you have a policy that states cavo-atrial junction and leave a catheter in the svc above that point.... you are open to problems legally. In going to our PI hospital based committee I brought to their attention that we have issues with adherence to the current policy of SVC and asked them to put more "teeth" in the process for when there is noncompliance. Instead they decided we should change to "great vessels" to allow for leaving tips in other locations when the risks out weigh the benefits of recannulating a patient.
My question for all of you is-- what does your policy say and what is actually happening? Are there situations where you do leave catheters in patients in other than the SVC?
The national standard is the lower third of the SVC at or near the CA junction and this should always be the goal. It is sometimes difficult to determine on chest xray alone that you are exactly at the CA junction. Use of ECG will tell you that level of accuracy due to p wave changes. Having tips high in the SVC increases the risk of problems such as tip migration so that is never the desired practice. I would only allow a tip to remain in a suboptimal tip location when all maneuvers to pass it to the correct location have failed. This has to be balanced against the type of therapy infused and the length of time it is needed. Suboptimal tip locations bring an increased risk of vein thrombosis, vessel erosion producing infiltration/extravasation. I would be uncomfortable with your proposed language of "great vessels". As an expert witness, this would be a red flag to me that I needed to look at the chest xray to determine where it actually was. If it was in a suboptimal location, I could easily provide research supporting the complication was directly related to this tip location. I think you are asking for much greater liability with the proposed change. 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
I am trying to pick up the position papers on this from INS and AVA. Recently published but not on either website. Do you remember what issues these might have been in ?
Jose Delp RN BSN VA-BC
We position our PICCs to the low SVC at the cavoatrial junction. Yes ....we have situations where either the PICC nurses or MDs can not advance past a certain point. We evalute the situation and often attempt to still get an optimal tip placement. ( ie try opposite arm ,IJ, tunneled IJ.....IF we can not for pathophysiologic reasons advance to optimal tip location and we are out of options...we look at risks vs benefit...call MD..review the case and make a decison...If we decide to use the line....we ABSOLUTELY document all of our efforts and assessment and consults and also provide and document our teaching. I also believe that these patients will needed increased monitoring so we can catch any complications early. I certainly do not agree changing your standard to indicate tip placement in the "great vessels"..rather I think that careful evaluation of the situation..excellent documentation and appopriate nursing care can solve the dilema
http://www.avainfo.org/website/download.asp?id=1447
INS
Standard 42.4 Which still includes the Rt Atrium. Interested to know if the revised 2011 Standards will drop the Rt. Atrium??
More from Lynn
http://hadawayassociates.blogspot.com/2009/09/when-to-begin-use-of-cvc.html
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Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.
Peter,
That NAVAN position statement was produced in 1998 - its 12 years old now.
Things have progressed along alot further since that statement was charted.
I agree with Lynn on this case - lower/distal 1/3 of the SVC or R) Cavo-Atrial junction is the gold standard.
Timothy R. Spencer, RN, APN, DipAppSci, BH, ICU Cert, VA-BC™
That CVC guy from Australia :-}
the AVA wwebsite says that position paper is under revison and not available at this time.
The second half of the original post questioned if there were ever times that you knew lines were left in other than the SVC? In other words policy versus actual reality.
Jose Delp RN BSN VA-BC