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Catheter Tip Verification on already placed VAD
Have not been able to find specifics as to "best practice" or "standards" on verifying VAD tip in catheters already placed.  For example, if a patient comes in to the ER with a VAD, what are others doing about tip verification in order to get "Line OK to Use" order from MD?  Are you just accessing the line for a blood return and if get one, consider the tip in proper alignment?  or.... are you requiring xray verification before the line can even be accessed?  My ED Chief needs guidane.  Thank you.
Screening for tip

Screening for tip location / migration is another use of ECG guidance. Flush your catheter with saline and obtain an ECG from it (see If the appropriate P wave is seen, you may confidently say the catheter tip is in the distal SVC. Costs about $16.00 to perform and takes about 1 minute.

A few years ago we had this

A few years ago we had this discussion at our INS chapter meeting. The majority of the hospitals represented stated that their policy was to obtain a chest xray on all patients with CVCs upon admitted to the hospital. Catheter tips migrate sporadically and spontaneously, so there is no specific time interval for a repeat chest xray, but all patients admitted with a CVC should be xrayed for tip location. If the catheter is found to be in the correct SVC/RA junction, it can and should be used. If not, it can not be used until it has been repositioned. Blood return will provide some information about the functionality of the catheter but it will not tell you if the tip has migrated. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

We also usually see a CXR
We also usually see a CXR ordered upon admission to the ED, but usually the port is accessed and upon verification of a positive blood return we use the VAD.I think its excessive to require a CXR for tip placement upon each visit..I don't think the insurance companies would ok the xray at a patients monthly VAD flush-so they would probally deny the CXR at each ER admission...I really don't see that many VAD tips that have migrated..usually its a poor blood return or flushing issues.
Beth George
Protocol recently approved

Does anyone have a sample policy regarding the xray to verify VAD tip on already placed catheters?  I recently submitted and had this approved and in order to put it into place we must have a policy in place.



Beth George, CRNI, VA-BC
Nurse Clinician/Vascular Access
UAB Medicine
Birmingham, AL

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