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Final PICC tip confirmation. Does your policy state the stylet must be removed prior to CXR/fluroscopy final confirmation?

The sylet allows the  catheter some rigidity which can alter the depth of the catheter once removed. I've seen a change in depth of up to 2.5/3 cm and on an infant that is huge...

What is your standard of practice? Removal of stylet prior to final CXR or leaving it in with final CXR and no f/u?

Stephanie Klee

Gwen Irwin
Final PICC tip confirmation

We do not have the stylet in place routinely for the CXR.  We remove the stylet.  We use a tip locator system and hopefully know the tip location, before the CXR.  We are not pediatric however and this might not help.

If it is a bariatric patient, we might leave the stylet in place, but then really not often.

Gwen Irwin

Austin, Texas

Angela Lee
I work in peds and do not

I work in peds and do not leave the stylet in.

mary ann ferrannini
 I personally do not leave it

 I personally do not leave it in...I much prefer to be creative in how I order my film so I get a good film.


We do leave it in for pediatric Picc placement. However, we do not have a Sherlock type device and all our Peds Piccs are put in when the pt is under moderate sedation. So to alleviate the potential malposition problems with a 6mo old.....We have the Dr turn the child's head, then once the picc is in and we have good blood return we call for the xray. The xray is taken under our sterile field (everone gets hats/masks/lead/machine covers/etc) before we break away the introducer. This way we can verify placement before the child wakes up and we have to start all over again.

No one is happy with this method but it is the only one we can agree on while other plans are out for comittee review.



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