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Wendy Erickson RN
Verifying PICC Tip Placement on admission/ER visit

Our policy states (based on the INS Standards) that when a patient is admitted to the hospital with a PICC line in place, a chest xray is done to verify correct tip placement prior to using the PICC.  My question:  What about a patient coming into the Emergency Dept.?  Do any of you require an xray in the ER?  Some of these patients end up going to CT from ER and the PICC is used automatically (we place all Power PICCs) without an xray.  Isn't this a double standard?  If so, where do we draw the line?  For example, a patient comes to the clinic for daily/weekly chemotherapy or other IV therapy - an xray is not done each and every time.  The mind set is "we've got a blood return, we are good to go!"

What is the best way to handle this?  Thanks in advance!


good blood return

One can get a good blood return from a PICC with its tip in IJ too. That was what happened to our pt. The IJ was ruptured from the contrast injection. In CT, they can do a pre-scan (scout?). On the scout of the chest a trained CT Tech can identify the location of the PICC tip. They can make their decision accordingly.

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