Forum topic

It is long but well worth the time to read. 

Well Julie May from Pennsylvania finally gave me the proof source I am looking for

The majority of PICC placers I am finding do not re-xay their PICC line if they pull back and it is too deep.  In fact they don't even count that as a malposition.

Legally there is no official record of where that tip is.  So if one goes to court the doctor told me to pull back does not work.  The doctor is not seeing a new x-ray film to now state it is in the right place.  One is dead in a coiurt of law.  Your documentation does not suffice.  You must re-x-ray all pull backs until the tip is confirmed SVC. 

In Lancaster a very nice out of court settlement was achieved in a child who had a PICC line placed too deep and the nurse as intstructed pulled baclk.  Guess what the childs abdomen was full of fluids and the child died.  We are lucky to have this case out of the Lancaster local newspaper as this was out of court and those are not public knowledge. 

 Fours years ago in Seattle there was a similiar case in an adult that did go to court and got a verdict in favor of the dead patient.  It was a subclavian placed triple lumen that was too deep on x-ray and the Dr. was told to pull back.  He claimed he did.  He charted it.  Oh Well!!!  No follow up film to show a thing!!!  Cardiac Tamponade occurred.

In both cases the article stated there was no follow-up x-ray to prove where that tip is.  I really don't care what you were told and by whom.  You must do a re-x-ray of these lines if they are too deep and you pullback.  You have to have valid proof not written documentation of where this tip is.  Safe practice dictates this.

 Thanks Julie May for the article in Lancaster that states there was no proof after pull back where that PICC tip was.  It was negligent not to have a follow-up x-ray on the chart.  A child died as a result.

If it were me I would re-x-ray the pull backs.  Hadaway, Moureau, Moosorli,Roth you do the legal cases am I crazy.  By the way if you want a copy of this article privately e-mail me at [email protected] and I will attach it.  Once again Julie May thanks.  The last two weeks half of the RN's I lectured to thought I was crazy and the other half re-x-ray after a pull baclk.

kathy