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frequency of re-x-ray for PICC tip placement

We have a patient who had a PICC placed to receive sedation for ECT treatments.  The tip was in good position at the time of placement.  She was having treatment once a week for a couple of weeks.  Now it's gone to once a month.  Now she is in for surgery and the question is...should we get an x-ray to check tip placement before surgery...and should they just use the PICC or start a peripheral I.V. for surgery. 

  Has anything been written about frequency of PICC tip verification?



Kristin Walker
We re-check tipp location on
We re-check tipp location on any pt that is admitted to our hospital with a central access device in place.

Kristin Walker RN, BSN, OCN Maui Memorial Medical Center IV dept.

There are no written

There are no written standards or guidelines about this, however there is a lot about tip migration after placement. So the best practice would be to always obtain a chest xray, especially if the catheter was placed at another facility, there are functional problems with the catheter such as no blood return, or you know there are factors that lead to migration such as coughing, vomiting, etc. Many hospitals have this policy. On the other hand, anesthesia may not want to use a PICC for their purposes anyway. I would want an xray to see where it is myself! Closest statements are INS SOP # 42, Practice Criteria M. Lynn 


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

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

It is possible to "screen"
It is possible to "screen" tip location anytime after placement by obtaining an ECG from a PICC line flushed with saline. If you see a P wave characteristic of appropriate placement (see or, you can be confident you are in the correct location as there is nowhere in the vasculature that you can see P waves of such voltage. (The P wave voltage in the proximal SVC is normally about 0.2-0.3 mV. In the very distal SVC it's usually at least 4 and, more often, 6-8 times greater. Once you see the procedure a few times, you will get a feel for where you are.)  (If you write me directly at [email protected], I can send you more details). If you only see a small P wave, then a CXR would be necessary.
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