We are a brand new vacular access team. (2 weeks) I placed a PICC last week and the chest Xray report is this: Portable chest was performed for PICC line placement. Extensive pleaural-parenchymal disease is seen on the left side. PICC line is placed on the right side. It is at the mid mediastinum and points under the aortic arch. Because there is a mediastinal deformity the exact apposition of this is unclear.
CONCLUSION: Deformity of the PICC line tip as described. the position relative to the superior vena cava is unclear based on these images.The mediastinum is distorted due to apical retraction. Repositioning may be necessary. Cross sectional imaging may necessary to document position of this line. Contrast injection under fluoroscopy may also document position.
My supervisor spoke with an interventional radiologist who placed PICC lines and he looked at the Xray and said to pull the PICC back 3 cm and as long as there was a blood return to leave it and let the patient go home. My concerns are: there was no written order to reposition the line, only the radiologist's conversation with my supervisor. She pulled it back and the patient was sent home. What is our legal responsibility in a situation like this? There was also no documentation in the patient's chart, only documentation in the PICC team office. I would appreciate any advice or comments.