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Power Injection and CVAD Tip Placement Verification


I am new to this forum, and would like to know how other facilities are verifying CVAD tip placement prior to power injection for power injectable CVADs. For facilities that are using the scout scan immediately prior, do you have radiologists available to do the interpretation of tip placement 24/7? Also, for power injectable implanted ports, is verification of blood return and patency sufficient, or is a visual image for tip placement prior to CT also neccessary i.e. do they have the same risk of malposition as CVCs and PICCs?

Thank you for your feedback,



Power inject ports

 The policy at my facility requires 2 identifiers of the port for power injection, one of which must be a scout film. Unfortunately the radiologists do not place in their readings if a port is power injectable or not. I have discussed this topic with several of them and they have no idea how to identify a port as being power injectable. I think it is a sad thing that when manufacturers get approval from the FDA for items such as these, that there is not some sort of common identifier that all have to have on the port. I know some ports have "CT" engraved on them but this is not always visible radiographically.

 Darla Tarvin RN VA-BC

Mercy Clermont Hospital

Power CVAD and Tip Placement

Thanks for your response! Our policy also requires at least two identifiers, and our radiology dept looks on the scout scan for the "CT" marking engraved on the port. However, we do not currently use the scout scan to verify tip placement in the SVC immediately prior to power injection for implanted ports, rather, we verify blood return and patency.

Do you know how your facility verifies tip placement prior to the CT for power injectable CVADs, including CVCs, PICCs, or implanted ports? We ran into some difficulty with requiring a scout scan verification of placement immediately prior as we do not have radiologists 24/7. Is this verification necessary? And if so, who reads the scout scans when the radiologist is not available?

In addition, are there facilities also conducting a post power injection CT scout to determine if there was malposition caused by the power injection? I am wondering how facilities would carry this out, in regards to radiologist availability etc...

Thank you!


 Jenna Trammel, RN, MSN, PHN


We usually do cavoatrial ECG and then finally CXR when confirming tip placement. Lower third SVC or cavoatrial junction is the preffered location for all PICCs we insert. In my opinion, when you insert the PICC you need to have some knowlege about CXR and tip position. In my oppinion, all radiologists read the film different. You should do your own interpretation after placing your PICC. I have nerver seen a misplaced powerinjectable PICC (we are using PowerPICC, Bard). This is at our institution in Sweden. 

Nurse specialist ICU/ANE/PICC.

Dep. of Neurosurgery

Umea University Hospital/SWEDEN


To clarify my question, in addition to the tip placement verification on insertion, are other facilities requiring an additional visual image for tip verification immediately prior and/or post each power injection of contrast (i.e. by scout scan?). If so, I am curious as to how the scout scans are being interpreted by the radiologist in a timely manner, and what the alternative is for when the radiologist is not available.

Thank you!

 Jenna Trammel, RN, MSN, PHN

Tip conf prior to scan

 We do not have any policy on "reconfirming " that tip placement is in the SVC prior to power injection during CT. You bring up a good point.

 Darla Tarvin RN VA-BC

Mercy Clermont Hospital

 What is stated in the

 What is stated in the catheter manufacturer's instructions for use about this issue? If they are recommending a scout scan, it would be in the best interest of each professional, your institution, and each patient to get this done. Sounds like the logistics are a problem. We are now seeing studies published about the tip movement caused by power injections and we have always known that many other things cause tip migration. 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

We do not require a tip

We do not require a tip reading on scout just prior to injection for the same logistical issues that you are probably talking about. Most places that I am aware of do not either. We require an SVC placement, brisk blood return and easy flush, along with "Power Injectable" identifiers. As for Power Ports, not only do you need tip position confirmation, and a brisk blood return and flush, you need to identify the implanted port as "power rated" for CT injection. We spent much time on this as it is related to liability of the nurse accessing a port with a power rated huber needle set. Obviously for Power injection of a port, you need to use a power rated needle set. Whomever is accessing the port with this power needle is signing off on the verification of the port itself as power capable. We require physical positive identification. The Bard Power Port has pysical indicators that are palpable. (check the website lit.). That is the only port we can access with a power needle just from palpation. They also need a "recent" CXR with tip confirmation. We decided within 30 days. Yes this is arbitrary, and we discussed limiting radiation exposure versus tip migration. All ports that are not palpable need to have radiographic evidence of "CT" markings on CXR or scout. Again this has to be a recent (30days) CXR or repeat if any question. The Cook brand ports do not at this time have any physically identifiable markings on thier power ports. I have spoken with the manufacturer and they say they include keychains or bracelets for identification. We do not accept these as evidence.

I will try to port my new power vad policy under resources so you can take a look. use whatever content you feel is appropriate.

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