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sue verbella
preferred tip placement of central catheters in the cavoatrial junction

need literature support other than INS and AVA to convince new IR physician that this is the preferred tip placement they are stating that there isn't any such place and all the other hospitals they work at place the tips in the atrium. Need quick response

Just look at the reference

Just look at the reference list on those INS and AVA papers. There are numerous articles on this topic. 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

Peter Marino

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

Show them the IFU that states

Show them the IFU that states the picc is not a right atrial catheter.  Dr. Verhey's article is a great reference as well, The Right Mediastinal Border and Central
Venous Anatomy on Frontal Chest
Radiograph—Direct CT Correlation. 

It's a short article.  I make a copy and take it to the radiologist and tell him that this is the standard for picc placement. Soften the experience by baking some cookies or brownies and deliver them at the same time.  Seriously, they are hungry humans under lots of pressure. Let them know you appreciate their prompt reading of your lines, you just need to all be on the same page.  

Tell them also that piccs in the deep RA can easily drop to the ventricle and cause arrythmias.  It happened to me today.  That is one thing they do not "get".  PICCs drop with arm movement or a distended abdomen pushes the heart up when the patient is supine allowing the tip to drop into the atrium.   You can see this on chest CTs when the pt. is supine with arms over head.  We get calls to pull lines back based on what is seen on CT.  When this happens we ask for an upright cxr before making any adjustments. 

I feel your pain.  We battle this constantly, variable reads from rad to rad.  We just do what we know is best but we have been qualified to read tips so we have some clout that way. 


Good luck




Darilyn Cole, RN, CRNI, VA-BC
PICC Team Mercy General Hospital Sacramento, CA


Gwen Irwin
Preferred tip placement of central catheters

At least 6 years ago, we had this discussion frequently with radiologists.  I told them that our policy would not allow us to leave a PICC in the atrium and the national standard would not support that either.  As doctors, they could make that decision, but as nurses, we cannot. They grew to accept that.  Somehow, they understand that our policies rule.

Gwen Irwin

Austin, Texas 

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