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rzenger
Ideal PICC tip location

I attended a workshop given by OHSU last year about RN radiographic confirmation of PICC tip location. During the workshop, the cavo-atria junction was considered the ideal location for PICC tip placement with SVC considered accetable. Where can I find an article to support the cavo-atrial junction as bein ideal PICC tip location? We are in the process of devloping an RN radiographic confirmation competency. It would be benefiicial to have an article supporting the cavo-atrial juction as being ideal tip location before we visit with the radiologists. Thanks for all of your help.

lynncrni
Check the list of references
Check the list of references in INS SOP #42 Catheter Placement. Are you concerned that the radiologist will prefer the RA location instead? There is no study that have directly compared the SVC vs RA. Check anything on this issue written by Tom Vesely, MD for a good overview of the issue. Lynn

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

anna liang
when the arm with picc is
when the arm with picc is raised toward or over the head, the tip can move to the RA or even RV. do we consider that as malposition or unacceptable?
lynncrni
This arm position would only
This arm position would only be temporary for a short period and then the tip should move back to the original location. So I would not consider this to be unacceptable. Tip migration to a distal vein or dislodgement of the catheter would be unacceptable. Lynn

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

Kris Pruner
I attended the

I attended the radiographic verification class at Savannah last year by Dr Todd Lovelace,MD.  He said to find the distal SVC/cavoatrial junction - Identify the angle formed by the shadow of the distal svc and right atrial appendage.  A PICC tip located up to 2cm proximal or 2 cm distal to this point will be considered within the distal SVC, The FDA recpmmemded location for a PICC tip.  I would like to find this ruling by the FDA.  My radiologist will never let me leave past the atrial appendage.

Kris Pruner RN, CRNI

lynncrni
The FDA recommendations to
The FDA recommendations to which you are referring can be found at http://www.fda.gov/cdrh/ohip/dupsa/cvcvideo.html

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

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