We recently had a Clinical nurse Rep. come from a different company for training on a non-ECG product and while she was here she was discussing where to leave a PICC tip in regards to height of P-wave. She encouraged us to leave the PICC at the first sign of No deflection rather than where the tallest P wave was acheived. It is my understanding from BARD training that the PICC is to be left at the tallest P-wave without deflection. The BARD/BD IFUs state was is printed below. What is everyone elses take here? I'm not sure what to do because now we have our clinicians doing different practices depending on whether or not they bought into her instructions.
ECG Confirmation
The Sherlock 3CG+™ TCS displays an ECG signal detected by the intravascular and body electrodes, which can be used for catheter tip positioning. In patients with a distinct P-wave, the P-wave will increase in amplitude as the catheter approaches the top of the cavo-atrial junction. As the catheter advances into the right atrium, the P-wave will decrease in amplitude and may be biphasic or invert
What evidence did this person provide to about to support the statements made? If nothing, then what is in the IFU for the device you are using? To my knowledge as tip location device use ECG. Some may not show you the actual tracing and use some other light mechanism but they are still using ECG. How do you determine "the first sign of no deflection"? You said this was not using ECG, so I guess I don't understand your point.
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
Sorry I may not have been clear. She was at our facility for a product that had nothing to do with ECG. We use ECG technology from BARD and it states in the IFUs to advance PICC to the highest Pwave as that indicates placement in the CAJ. This clinical nurse rep. Stated she leaves her PICCs at the deepest point were no deflection is seen And doesn't continue to check that this is indeed the highest P wave.
Thanks for the clarification. I don't know what company this nurse represents, but she/he should not be making statements about practice with other devices. You are accountable for following the IFU for the ECG based tip location device you are using, thus you follow what is in the IFU for the Bard product and not this nurse.
Anytime a representative for a manufacturer, sales rep or clinical rep, states something to you, you should expect to see what they said in writing from the company. If they cannot produce it, do follow what they say.
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