What is the current feeling about a picc tip in the right atrium?
It would be helpful to know why you are asking this question. I am assuming you are referring to adult patients.
I know that some docs are promoting that picc tips be left in the atrium. It is my experience that a picc too far into the atrium can cause arhythmias especially on short people and people with large or very bloated bellies. We've had to pull back perfectly placed piccs because of subsequent runs of vtach. PICCs migrate up and down the SVC with the patient's position and arm movement. It is not unusual for a picc that is at the cavoatrial junction on an upright portable to be seen 1-2 cm in the atrium on a supine film.
We often get called by radiology to pull back a picc because it showed up on a CT scan as being in the RA. When the patient is supine on the table with their arms over their head the line will drop.
Of course there is the wide variation on tip interpretation as well. Our team promotes the Verhey article which demonstrates the CA junction at 1-2 cm below the right atrial appendage/ SVC junction. Some Rads will call this RA. We try to educate them.
I hope this helps. Oh ya, read the instructions for use for your catheter. It probably states emphatically that it is not a right atrial catheter.
Darilyn Cole, RN, CRNI, VA-BC
PICC Team Mercy General Hospital Sacramento, CA
The correct location for all CVADs, including PICCs, is the lower third of the SVC near the cavoatrial junction. They should not be placed inside the right atrium however as Darilyn said, arm movement may cause the tip of a PICC to move into the right atrium. Placing the tip inside the right atrium has long been a controversial issue but there is now consensus among physicians and nurses who are VAD insertion experts that the cavoatrial junction is the most appropriate tip location. Chest xray is difficult to confirm this precise location however it is quite possible with ECG technology. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
Thank you for the input. Cavo atrial is our target. We have a new perdiem RN who works in an IR dept and stated her docs want the line in the RA. I was certain that CA junction placement was optimal.