We have a pediatric intensivist who has on more than one occasion placed a picc line where the tip is shown on cxr to be in the brachiocephalic. When questioned that the line is malpositioned he states that was his intended target. On further discussion he states that SVC tip placement in pediatrics is not required as it is in adults. I know of no literature that supports this and would think that positioning in the brachiocephalic would have the same risks for complications in the pedi population as it does in adults. I would apprecaite any input on this, particularly from those that work with this group of patients.
I would recommend you use the resources from AVA's Pediatric Special Interest Group to support the tip location in the lower SVC. Also, the Infusion Nursing Standard on VAD Malposition. There is concern about catheter tips in neonates that migrate into the right heart then producing pericardial effusion and cardiac tamponade. I would set the expectation that he provide evidence from the literature to support his position. This information should all be shared with the appropriate committee that will exam the issues and write the hospital policy applicable to every inserter. That is what should happen in a collegial collaboraative practice. You should also enlist the risk management dept to be involved with this decision. Do you currently have a Nursing policy stating appropriate tip location? If so, you can continue to practice under that policy. This creates the issue of 2 different tip locations and the need to track outcome data of both locations. This becomes your own evidence as to outcomes, which is what it should all be about. 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