Is a PCXR for tip confirmation on prehospital PICCs needed, prior to use, on piccs that have been placed in that same hospital? We currently require this of any prehospital picc that comes in as a direct admit or ED admit. The question was brought up because we do not require a PCXR for tip confirmation before use on our patients that come into the infusion clinic for their daily abx. If we have documentaiton from insertion and tip confirmation is it ok to just use it?
If an individual is coming to your infusion clinic with a PICC in which you, or your fellow nurses/MD's placed, I would want an XRay if there were s/s of catheter dislodgement or migration or if proper placement was in question.
Is the external portion of the hub the same length that it was last week? Is the patient experiencing any s/s of it migrating to another vessel? Are you still obtaining a brisk, free flowing blood return?
If you are able to answer ALL of these questions appropriately, and these questions are assessed and documented with each and every visit, then I wouldn't expect to do CXR with each visit they make.
So, is your clinic freestanding or is it associated with the hospital as above?
We had this discussion last year and put into place a 30 day rule. If patient had line placed at the same hospital AND all the questions listed in the previous comment or good AND there has been a CXR within 30 days it is good to use OTHERWISE CXR is needed. For all lines l\placed outside of hospital then a CXR is needed. The only thing you can do with a line prior to CXR is draw blood as it is part of the assessment for good blood return.
Joy Selchow RN, BSN
Nurse Manager
IV Therapy Department
It's not a matter of duration, it's about tip placement and changes in Intrathoracic pressures.
Example: PICC is placed in a Cystic Fibrosis Pt. 10AM, tip is in Cavoatrial junction, brisk blood return noted. 5pm blood return noted to be sporadic. CXR confirms PICC tip is in the subclavian and catheter is doing a "u" turn in the SVC. (this tip flipping / migration occurred over the next 3 days with the tip landing in different locations and the catheter having to be corrected via IR 4 times (even with optimal tip placement). The third time IR says the RN's are causing this by flushing to aggressively (roll eyes).
Clinical info: Pt was coughing violently at times causing him to vomit.
Valsalva, coughing and vomiting all change intrathoracic pressures and can cause catheter tip migration and malposition. Really has nothing to do with how long a catheter has been in place.
BTW we have no written policy, but I always suggest a CXR be taken on admission, reguardless of when the PICC was inserted. Then you have a base line on which to assess non-resistant flush and brisk blood return.
I've seen contralateral PICC's with great blood returns and easy flushes.
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.