A few months ago there was a discussion regarding central placement of ports. I think there was an issue with a surgeon who was placing them outside the SVC. I have a similar situation. We have a surgeon who insisits on placing them in the upper third of the SVC and the tips are then migrating outside of the SVC. He's insisting that they are still ok to use and is refusing to consider placing tips any deeper. We have a meeting scheduled soon and I need all of the evidence I can find to support lower SVC placement. I have the INS standard and I know that ONS refers to INS. Any help would be greatly apprectiated.
A literature search on tip location of central venous catheters will bring up several resources for you. There is also the catheter manufacturers instructions for use and there may be references listed on that document. This is found inside a catheter package or call the specific manufacturer to request a copy. Some also have their instructions on their website.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Also, if you look for tip location and complications, you will find articles and studies that indicate increased risk for DVT with upper SVC placement.
Here are a few that I have found:
Cadman A, Lawrance JAL, Fitzsimmons L, Spencer-Shaw A, Swindell R. To clot or not to clot? That is the question in central venous catheters. Clinical Radiology (2004) 59, 349-355.
Luciani A, Clement O, Halimi P, Goudot D, Portier F, Vassot V, Luciani JA, Avan P, Frija G, Bonfils P. Catheter-related Upper Extremity Deep Vewnous Thrombosis in Cancer Patients: A prospective Study Based on Doppler US. Radiology (2001) 20 (3) 655-60.
Kuter DJ. Thrombotic Complications of Central Venous Catheters in Cancer Patients. The Oncologist 2004;9:207-216.
Gwen Irwin