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allenmob
PICC tip cleared by MD
I work part time for an agency placing PICCs in LTAC facilities.  Most of their MDs won't verify PICC placements on patients not their own.  Radiologists will call verifying the tip in SVC but the nurses won't use them because the radiologist hasn't actually said they can use it, just pointed out where the tip is.  I find this nonsense and semantics ridiculous.  Sometimes they can't use the PICC for 2 or 3 days!  How silly that in my state a nurse can put in a PICC but not verify placement.  Sometimes I feel sorry for them and start an IV if I know they really need the access right away.
Carol Stewart
Our facility developed a
Our facility developed a policy where the PICC Line nurses could verify the line placement after taking a course with one of our radiologist and I also took a course offered by Bard Access Systems specifically designed for PICC Line nurses to be x-ray certified to verify line placement. This was an excellent course and I would highly suggest trying to implement such a program at your facility.

Carol Stewart Rn, BSN, PICC Cert

allenmob
I've been to such a course
I've been to such a course but in our state it doesn't matter.
ckcrnipicc
Itg might help if the policy
Itg might help if the policy and orders stated- if PICC tip in SVC line is ok to use.  Our radiologists then do not have to give an  order ok to use- because it is part of the protocol order.
Gwen Irwin
Our radiologists would not

Our radiologists would not give an OK to use order either.  They would only say that the tip was in teh SVC.  They didn't want to sign a verbal order in medical records, so would not give a verbal order.

We changed our PICC insertion orders to say if the tip was confirmed in the SVC, it was OK to use.  We would enter the name of the person (radiologist or other physician) that confirmed the tip in the SVC on the PICC insertion ordres. This made the radiologists happy, since they didn't have to sign another order page.

Since the PICC nurses are confirming the tip location now, the radiologists are not concerned about those situations at all.  Our policy covers the PICC RN confirming the tip location.

Hope this helps.

Gwen Irwin

Austin, Texas

anna liang
in our facility, the
in our facility, the MD/primary team who orders the picc needs to 'ok' the picc before use.
Radiology's job is just to verify where the tip is, e.g. SVC or IVC. just because the tip is in SVC or IVC doest not necessarily mean it is the optimal location. there are cases that we can't leave tip @ either SVC or IVC -- you don't expect the Rad will go through the medical records to find out if it is 'ok' or not.
whoever orders the picc should be responsible for the tip location
lynncrni
I see absolutely no need to
I see absolutely no need to have a physician's order stating it is ok to use a catheter that is positioned in the SVC. Write your protocol to address this and the problem goes away. Of course the radiologist will have to provide an anatomical description about where it is located such as "appears in the  SVC, etc, etc." Lynn

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

Nadine Nakazawa
We faced this situation when
We faced this situation when I first started the PICC program back in 1990.  So we wrote the procedure as follows:   The radiologist will determine the location of the PICC tip, usually verbally, and the PICC nurse will document the name of the physician and the tip location, any adjustments made (we use a temporary sterile wrap, and then adjust it sterilely), and document the final tip location.  The PICC nurse document "OK to use PICC." on the written documentation, or put in an order in the computerized medical record "OK to use PICC."   We've been doing this for 17 years and it seems to make all parties feel comfortable.   It really is up to the PICC nurse to make sure the PICC is adjusted and the procedure completed to give the OK to use.   The radiologist only confirms the tip based on the CXR; he/she is not adjusting the PICC, and therefore cannot assure that it is OK to use.   I hope this all makes sense.  

Nadine Nakazawa, RN, BS, OCN, CRNI, VA-BC

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