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estevens102206
Using ultrasound for PICC tip location
Is anyone out there using their ultrasound probe to check the location of the PICC once inserted? Is this a technique that could be used instead of purchasing a separate tip location system like the Navion or Sherlock? Are there problems with keeping a sterile field while using ultrasound for this purpose? Thanks.
Jerrbear
 We currently use it

 We currently use it routinely to check for malposition in the internal jugular.  We have caught several, and it saved us from having to shoot multiple x-rays.  There was one that I failed to catch with the ultrasound, however, so it isn't foolproof, at least not in my hands.  The trick is to hold the probe at the back end so you don't contaminate your gloves, and then be sure you don't plop the contaminated probe back into your sterile field.  I haven't had a chance to try any of the TLSs so far, but am eager to try out the Sherlock.

Jerry Bartholomew RN, BSN, CRNI

VA Medical Center, Spokane, WA

Jerry Bartholomew RN, MSN, CRNI

VA Medical Center, Spokane, WA

lynncrni
Ultrasound is not designed
Ultrasound is not designed for or intended for use to identify the tip location inside the thorax. As Jerry said, it can be used to rule out jugular placement before breaking your sterile field but can not identify the tip location inside the chest. Navigator and Sherlock can give you a general idea that your tip is in the correct place, but can not replace a chest xray. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Heather Nichols
I myself have never had much

I myself have never had much luck using the ultrasound for tip confirmation (and I have tried), especially in the chest.  The neck is debateable.  The cost of a navigation system can be offset on several levels if you are interested.  E-mail me privately if you are and I can probably help you out.  We have used the Navigator now, very successfully I might add, with cost savings, for about 5 years, and we are a University hospital.  Cost is VERY important around here. 

Heather

nancymoureau
I do use the ultrasound to

I do use the ultrasound to check for jugular placement each time. Since I use different PICCs I do not have the option to use the Navigator or Sherlock each time. The ultrasound probes we are using for vascular access are not designed for SVC determination. I am holding out for more accurate tip location readings with ECG similar to what they are beginning to use commonly in Europe.

Sorry I have been gone so long, trying to catch up on deadlines and having antiviral program challenges with this website. May have found the solution now. Glad to be available privately for questions anytime.  [email protected]

Happy New Year to all!

 

Nancy Moureau, BSN, CRNI

PICC Excellence.com

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

PICC Excellence, Inc

 

Chris Naylor
I have not used the probe
I have not used the probe routinely to check the neck. I have tried on patients when I had a line up the jugular and wasn't able to visulalize it, so am probably doing something wrong.  We have been using Sherlock since July and have had very good results with knowing the direction of the catheter. It has been 100% accurate and is hands off which is an advantage.
DML RN
I have made it a habit of

I have made it a habit of scanning the jugular after every placement. I looked over my last few record sheets today. Of my last 70 lines,I was able to spot the line in the jugular and get it turned 5 times,so saved 5+ CXR's. In 2005,my repeat CXR rate was around 10%. Since I've become more diligent about checking the jugular and more adept at spotting the line if it's there,it's down to around 5%. So,it's a helpful trick to implement.

On one occassion earlier this year I had a line in a cephalic that kept going retrograde into the basilic--when you flush and hear a turbulent 'spurt' in the upper arm it's a good sign of that malposition. Couldn't hear the turbulence after I did a repositioning but CXR still showed the line in the arm. I was able to see his subclavian on US and had someone hold the probe while I re-readjusted until I saw the line show up there.

 

Laura Cook CRNI
We use the Navigator at our
We use the Navigator at our facility.  It is very accurate.  It tells you exactly where the catheter is and which direction it is heading.  We love it.  We do not do very many repostions at our facility at all.
anna liang
imagine how echo is done: do
imagine how echo is done: do the techs place the probe on the sternum?

there is one article that compare echo image of picc tip to cxr image (can't remember where now).


Linda C Motley
Sorry, That needs to be sent

Sorry, That needs to be sent to

[email protected]

Thanks again,

Linda

DCrni
Flushing the catheter while

Flushing the catheter while scanning the neck will almost always catch jugular tip placement even when you can't see the catheter.

Watch closely for "stars" or "sparkles" while flushing. 

You'll be amazed.

 

Darilyn

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

 

kokotis
Using the ultrasound probe

Using the ultrasound probe to identify a jugular malposition is not foolproof as you will miss come.  You would likely catch at least 50%

 

The other trick would be to maintain sterility with one clinician in the room.  It can be done but remember the neck is not prepped and you may lose one appendix to contamination when you have to reposition and check the neck again.  With a full body drape as recommended by the CDC for full barrier it is even more difficult.  I don't know if you have noticed it but the drapes are getting bigger and covering more of the patient

 

Kathy Kokotis

Bard Access Systems

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