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RiderRN
Physicians signing off PICCs with tips outside SVC ok to use

How do other clinicians manage requests from physicians to use PICCs with tips outside the SVC? When my team is unable to drop the catheter tip to the CAJ/SVC, most times the physicians will say it's good enough and ok it for use (even pressors/vesicants). My recommendations are to remove and replace in IR, but rarely do they.

Is there literature I can give them or studies on outcomes related to tips outside the SVC? It makes me cringe personally but I feel the physicians have final say. Is this something I shouldn't worry about since they do have the final say and I chart this very descriptively? Lynne?

Regards,

Kate

lynncrni
Use INS SOP CVAD Malposition.

Use INS SOP CVAD Malposition. read this standard and then locate the needed references. Read and use those references as strong evidence to support the correct CVAD tip location. These references are MEDICAL studies, authored by their physician colleagues. Do not just show them the INS document as many physicians will mistakenly ignore it. This document is written based on evidence from ALL healthcare but save time by finding these medical studies referenced. These studies clearly state that suboptimal locations are dangerous. You and your team members will bear the legal burden if there is a serious problem with these tip locations. Regardless of what   the physicain order, you will be named in the lawsuit. Also, take this issue and evidence to your risk management dept and medical QI/QA. Work toward getting an appropriate written policy approved by the applicable committees. Do not try to do this by approaching each physician individually. Work for a facility wide resolution. 

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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