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repeat x-ray after pull back of too deep PICC tip is mandatory for legal purposes as proof in a court of law

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.









This is a situation where
This is a situation where decisions by the courts will have a definite influence on our practice. I would take this a step farther though. It is quite possible for the catheter to have been sufficiently pulled back to the proper position, then have become malpositioned again during use because of inadequate catheter stabilization, excessive arm use in the case of a PICC, a tunnel too large for the subq tissue to grow into the cuff, etc. This chest xray after repositioning the catheter will provide the evidence that the inserter met the standard of care by the repositioning. If the malpositioning occurs again, the burden of proof would lie with the nurses providing the routine care of the line. Technically speaking if you have a catheter in the right heart, and you calculate the distance to the lower SVC, and retract that specific amount, there should be no place else for the catheter to go. But these outcomes have created a new standard of care. 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

I do not say re-xray is

I do not say re-xray is mandatory but I explain, exactly as you have, that it will cover you if a problem arises. The last x-ray in the patient record must be correct or you are liable. I do work with many cases of improper terminal tip placement. Also see the JAVA issue that just came out with an article on a case I testified on with subclavian tip placement. They did not x-ray at all. Huge judgment against the hospital, incorrect placement.  

Nancy L. Moureau, BSN, CRNI                                                                           PICC Excellence, Inc                                                                   [email protected]


Nancy L. Moureau, BSN, CRNI, CPUI, VA-BC

PICC Excellence, Inc


Timothy Royer B...
Excellent Issue of JAVA. 
Excellent Issue of JAVA.  Nancy, I am having my staff read the article, as well as the rest of the Journal.
I just read this. How does a
I just read this. How does a PICC placed to deep wind up emptying into a child's abdomen? Granted, I don't do peds, but I don't understand this scenario.

Victoria Sallese, RN, VAT, PICC service

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