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Denise Harper
2 PICC questions

Post PICC CXR, radiologist suggests pulling back, do you re-xray all, just if pulled back more than certain amount (say 5 cm), or not at all?

We were re-xraying those pulled back 5cm or more but our medical director says we should re-xray all.

For those placing outpatient PICCs--do you have to have a history and physical and complete nursing assessment? Can you share how your process works from start to finish?

IR does our outpatients right now and require H&P w/n 24 hours and a full nursing assessment. Administration wants us to take over outpatients but we're not sure what we need to do or how.

Thanks so much.


in my hosp, we (2 rn's) do

in my hosp, we (2 rn's) do all piccs,  one nurse full time and myself parttime.

all the radiologists do is read the cxr.  for my neurotic self, if i do any manipulation to a picc, i get a cxr.


you will have no proof that
you will have no proof that the tip was repositioned if you don't...leaving you open to questions you can't answer....protect yourself
Kristin Walker
We leave it up to the

We leave it up to the radiologist as to whether or not to re-xray.  It is also written on the previous CSR what was done to that line after the CXR was done. (ie, "Picc to be pulled back 2cm by IVRN per Dr Doe".

As far as your outpt insertions go, you should follow whatever process your hospital currently uses to process outpt's.  For example, our hospital requires that all pt's being admitted for outpt procedures have MD oders, a short H & P and then whatever documentation is required for that particular dept they are being admitted to.

Hope this was helpful.

Kristin Walker RN, BSN, OCN Maui Memorial Medical Center IV dept.

Our policy is that the Rad

Our policy is that the Rad has to specify how far to withdraw the PICC, we ( the PICC inserters) are the only ones that are allowed to adjust PICCs. We don't re-xray, just chart. The only time we rexray, is if tip was difficult to visualize on the first x-ray.

Good luck getting info on out-pts. I've stood toe to toe with a Dr telling me that I'm only putting in a PICC, why do I need to know allergies or anything else?!!

I place all the out-pt PICCs, alone, in an office that few people would find if I had an emergency! Think it's handy to know allergy to latex, allergy to contrast (in case I need IR to take over), etc? How about that pt has a seizure disorder? I do.

I have a referral sheet the Dr is to fill out and sign, as well as the Dr order sheet. Sorry to sound pessimistic, but even with sending out a letter to most of the docs (Ca Clinic esp) about the importance of giving me basic info, some are great and others are like the above mentioned.

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