If there is patient admitted from another facility with a PICC line in place is it recommended practice to obtain a chest xray to verify tip placement upon admission?
The concern is accurate tip location. Even if you have a written result from a chest xray, there is no guarantee that the tip remains in the same location but this is true of whether the CVAD was inserted at your facility or another one. The national standard is for the nurse to be able to recognize malpositioned catheter tips by the signs and symptoms, but this could also cause many to be overlooked. Nurses still need to know these signs and symptoms regardless of when or where any CVAD is placed. There is no national standard for repeating a chest xray on any CVAD any any specific frequency because tip migration is sporatic and unpredictable.
The other question is whether the catheter tip was originally positioned correctly. It may have been too short or purposefully placed in the midclavicular position. Infusion through these catheters increases the incidence of many complications. Chest xray on admission is the only way to know what you have exactly for safe infusion in your facility. Lynn
I agree with Lynn. It is our protocol to get CXRs of all incoming PICCs even our own. Most usually have had a CXR for other reasons so I rarely have to order one.
We do here @ GMC, yes. If we inserted the PICC, the pt went home and came back, we don't require one unless there are complications. I hope this helps
Tracey Roulinavage RN BSN VA-BC
The concern is accurate tip location. Even if you have a written result from a chest xray, there is no guarantee that the tip remains in the same location but this is true of whether the CVAD was inserted at your facility or another one. The national standard is for the nurse to be able to recognize malpositioned catheter tips by the signs and symptoms, but this could also cause many to be overlooked. Nurses still need to know these signs and symptoms regardless of when or where any CVAD is placed. There is no national standard for repeating a chest xray on any CVAD any any specific frequency because tip migration is sporatic and unpredictable.
The other question is whether the catheter tip was originally positioned correctly. It may have been too short or purposefully placed in the midclavicular position. Infusion through these catheters increases the incidence of many complications. Chest xray on admission is the only way to know what you have exactly for safe infusion in your facility. 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
I agree with Lynn. It is our protocol to get CXRs of all incoming PICCs even our own. Most usually have had a CXR for other reasons so I rarely have to order one.
Mary Penn RN VA-BC
Saint Charles, MO
If the catheter was inserted outside our hospital system and particularly if the catheter is identified by external markings as a PICC
We get a CXR to confirm catheter tip location
MANY times these catheters have been trimmed and the tip resides in the Midline or Mid Clavicular region
Robbin George RN VA-BC
Robbin George RN VA-BC