Just wondering what the practice is for institutions for reconfirmation of CVC tip location for patients with longer term central lines. As per the new standards, routine chest xrays are no longer required due to the sporadic and unpredictable nature of tip malposition. Besides assessing difficulty flushing and negative blood return, there are many other considertions for tip malposition to take into account, in which you can flush your line and get a blood return.
Does your institute have a documented method of tip confirmation, post procedure. If xray, how often is this done? And do you have physician and or radiology confirmation that the line is okay to use.
Thank you all for your time.
Routine chest xrays were never the standard for patients admitted with any type of CVAD already in place. Actually the standard on Malposition did not change much from 2021. The standard is for all nurses caring for patients with a CVAD to know the signs and symptoms of malposition. They are listed in the the standard. This can happen at any point in the hospital stay and is not limited to those that are being readmitted with a CVAD. There are plenty of examples of hopsitals that do and do not automatically obtain a chest xray on admission when a CVAD is in place. This is a policy that the practice committee must decide. You should have documentation of the original tip location, assess the site condition and external catheter length and compare to original, assess all other signs and symptoms listed. Change dressing, confirm blood return and absence of any s/s of any complication. No documentation of original information and/or any questions about other s/s means a chest xray.
Not sure what you mean by xray post procedure. If there is no s/s that the CVAD is malpositioned, there is no need for a repeat xray. If the CVAD was inserted in the OR and there is no xray of tip location, then there is a need to get a chest xray postop. Exposure to xray must be kept at a minimum so there is no recommendation for a repeat chest xray unless there is a clinical indication for it. Learn to assess tip location on xrays for all CVADs. I have never understood the need for a order from a provider that "line is ok to use". Once it has been confirmed to be in the CAJ or lower SVC, it is used. VAD inserters frequently assess chest xrays for tip location and begin infusion, but this is not the same as "reading the xray".
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