suppossed you have a 42 cm picc line with tip at the CAJ with 0 cm outside of body. If this catheter should migrate out of the body, is there a minimum standard number of cm‘s that would require a call to the Md?
I believe that every organization should have their own P&P about this. Given that te SVC in a 'normal" adult is approx 7 cm in length, if it is at the CAJ with no catheter external, then, do you contact the MD for repeat CXR after 3 cm retraction, 5 cm retraction..??? Are the other facts about the IV catheter still present?
So, let's say it has been pulled out two cm, do you still have a brisk, free flowing blood return? Has the site description changed?
Or, now it's 4 cm out, but it is sluggish to flush and you do NOT get a good blood return, would you get a repeat CXR then? So, I believe that the entire picture should be assessed. The company I work for uses the 2cm rule.
Correct! Add assessment for any other complaints of discomfort in the chest or back. Retraction can cause tip to migrate into tributary veins. Eg, azygous joins SVC on posterior side at level of 2nd intercostal space. This could cause discomfort in back. 2 cm rule is reasonable good policy, I think.
I believe that every organization should have their own P&P about this. Given that te SVC in a 'normal" adult is approx 7 cm in length, if it is at the CAJ with no catheter external, then, do you contact the MD for repeat CXR after 3 cm retraction, 5 cm retraction..??? Are the other facts about the IV catheter still present?
So, let's say it has been pulled out two cm, do you still have a brisk, free flowing blood return? Has the site description changed?
Or, now it's 4 cm out, but it is sluggish to flush and you do NOT get a good blood return, would you get a repeat CXR then? So, I believe that the entire picture should be assessed. The company I work for uses the 2cm rule.
Correct! Add assessment for any other complaints of discomfort in the chest or back. Retraction can cause tip to migrate into tributary veins. Eg, azygous joins SVC on posterior side at level of 2nd intercostal space. This could cause discomfort in back. 2 cm rule is reasonable good policy, I think.
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