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Patty Luptak
Justification of INS Standard 42.4 Catheter Placement

I have a vascular surgeon challenging this standard and it's references stating that they do not support evidence based medcine 1a. I have emailed INS to help me but have received no support. I have given this MD AVA's tip position paper put he classifies his CVC lines "different" from our PICCs. The issue started when he placed a CVC and left the tip in the innominate and the nurses in ICU refused to use the line based on a policy I wrote. I have gone around with this guy for 3 days now and I am out of articles and ideas to support this standard to satsisfy him. He is a major surgeon here and will not let this go. I won't even tell you what occurred to resolve the issue. If anyone can help with any articles to support other than I have already, I would appreciate it



Patty,  There is quite a


There is quite a lot of information in the studies, from the manufacturers, and from the FDA about the best outcomes associated with tip location at the SVC/RA junction. Anything distal to that is suboptimal. A CVC is defined by its tip location, not by the vein of insertion or who is placing it. Since I don't know what you have used, I don't know what you could add. 


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

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Patty Luptak
I have used all of the

I have used all of the references that are listed at the end of the standard 42 Catheter Placement in the Infusion Nurses Society's Standards of Practice which include the KDOQI Guidelines, Dr.Tom Vesely's article, and countless studies. I gave him the AVA tip position statement as well and he argued that a CVC is different than a PICC. You see what I am up against. I think the bottom line is he doesn't want to be wrong no matter what I show him and I have given him plenty of literature to support what is best practice. If you have recent studies or articles other than INS articles, I would appreciate that information. My email is [email protected]



Patricia Luptak RN OCN MS


Chris Cavanaugh
Patty, Have you tried


Have you tried showing  him the instructions for use for the catheter he placed?  Most, if not all manufactures state the SVC as the location for the tip of the catheter.  If he does not place it there, then he is using the product off-label and against the manufacturers recommendations, putting him liable for any untoward events. 

The SVC tip location for any central catheter is suppored by SIR, FDA, CDC as well as AVA and INS.  I am happy to supply these references for you, as well as Instructions for use for central lines that I may have, let me know if I can be of assistance.

Chris Cavanaugh, CRNI

[email protected]

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

Patty Luptak
Chris, I will try that


I will try that argument with him, that is a good point but I don't think he will care. I gave him all of the articles that support the standard for INS, and I gave him AVA's Tip Position Statment which he says doesn't apply to him because it is about PICCs. I have the CDC but if you have SIR and FDA I would appreciate them. If you can email them my email is [email protected] or my fax is 412-469-7338

Thanks so much


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