We are revising our implanted port policy and looking at best practice when doing so. We use Lippincott as our procedure based reference. Prior to accessing an implanted port it states to "verify tip location". It does not say "how to" verifty tip location.
Our current practice is to review in the medical record the tip location upon insertion, access the port and require a brisk blood return before using. If we do not have tip location of the device within our medical record we obtain from inserting facility OR get a chest xray to confirm location.
My question: Does anyone use other methods of verifying tip location? Do you use the product id card that the patient is given? This typically only states the type of port and when it was inserted but does not validate tip location. Do you not verify tip location and use upon a blood return? I wouldn't want to do this as a blood return can be present and the catheter malpositioned. Thoughts?
Go by the INS Standard of Practice on CVAD Malposition. There is no requirement for a repeat xray at any particular time such as on admission, etc. Tip malposition is a very sporadic problem but it does occur. Some facilities do have a policy to obtain a chest xray for tip locaiton on admission but most do not. The fact is you can have a tip located in the lower SVC on admission, but have it migrate to the IJ the next day. The key is knowing the signs and symptoms of malposition, and immediatley getting an xray when they present. Additionally blood return is a critical element of assessing patency for all VADs. So put lots of emphsis on this step. See more details in the SOP on Malposition. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861