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ladena rhoden
X-ray verification

For those of you who still must rely on radiology for 'preliminary' tip readings of central lines/PICCs:

What does your institution accept as correct verbage:

 PICC tip OK

Central line tip appears in good position; no pneumo

or are they required to name anatomical location?

I hold out for the

I hold out for the anatomical location.  We have one rad. guy in particular that this reaaallllyyyy aggravates, but have to have that to document placement within the standard.  Our IR doc and others purposefully place lines in the RA (????), so just to have "OK" would be too vague.

I insert pediatric PICCs. 

I insert pediatric PICCs.  I have to call each pediatric team everytime I insert a PICC for THEM to go look at the x-ray.  The order to use from the docs usually states "PICC okay to use". 

I am currently trying to get access to our 'nex-rad' system so I may view my own films in addition to the doctors viewing them.

Karen Day
Karen Day's picture
we use anatomical location

we use anatomical location as well; we usually state

CXR read by Dr. _______ and states tip of picc line is projected in the region of the lower SVC.

 we quote exactly what the radiologist states in his interpretation so as not to make any mistakes on tip location.


Chris Naylor
We read our own now, but in

We read our own now, but in the past we only allowed the anatomical position in the SVC.



we only wish we could verify
we only wish we could verify our own tip! how easy that would be.  tho we do have access to our films, we do check our own and have them repositioned before they are even ok'd for use if need be.  we ask for anatomical location only because it may be ok to use, but is it the best position?  our peds intensivists like them in the upper third of the SVC, and we have been goin gat this for a while and making some progress as we feel that is not an appropriate placement.  these lines are ok to use, but not in the best interest of the patient. 
rivka livni
Now that we have PAX I got

Now that we have PAX I got all our chest radiologists to read the tip in relation to Cavo-Atrial junction. So it says "tip position is in SVC, about 2cm above Cavo-Atrial junction" and so on. It is very helpfull especially since most of our patients get readmitted, the next PICC length is so easy to caculate. If the tip is malpositioned in another vein other then the SVC, they page me immediately.

I can not stress enough how important it is to establish a great relationship with the chest radiologists and the X-ray techs. 90% of the time I have the results within 20-45 minutes after completion of insertion.

ladena rhoden
Thanks to everyone for their

Thanks to everyone for their input.  I am happy that some have been able to persuade their radiology group to use anatomic location.

We have always had an excellent relationship with our rads.  When we got our PACs system up and running, this trend began with not wanting us to come down and consult directly with them - because this messes with their voice recognition program.  They want us to go to the computers on the floors to look at our xrays and get the preliminary read.   It is just recently that they have dug their heels in on this issue of terminology. 

Perhaps I am not the only one having menopausal problems, Huh?

Terraine Spurdens
I insert picc lines only in

I insert picc lines only in adults..we don't have a pediatric picc program here.  We insist that the radiologists give us the anatomical placement..because we can't leave them in the RA but the radiologists state that they do and that it is ok!

We are going to be taught how to read our own reports for placement..but I have a problem when a radiologist can't find the tip and we are now going to do the reading..


Our Nursing Policy states

Our Nursing Policy states that before use(except in an emergency situation)

a central line must have x-ray verification that the tip is in the SVC.  We have a

sticker that must be placed on the chart with the name of the inserter and the

anatomical tip placement.  One of our more irritating docs, somehow, after the

policy was written, had added "or unless the physician orders otherwise".  But

if a physician orders otherwise, the nurse calls the PICC nurse who evaluates the

situation and calls the physician if she feels the order to use is inappropriate.

T. Nauman RN, CRNI

Diane C Lauer
The board of nursing in NH

The board of nursing in NH requires an MD Order to use the PICC line.  The most recent trends state the line is verified by a radiology dictation which would state the anatomical location of distal tip.  For example the rad dictation reads 'distal tip the lower third of the superior vena cava'  or something to that effect.  Which doctor writes an order for the nurse to be able to use the line?  Anyone in NH or New England out there willing to share how they handle this?

Celia Brown

Diane, I am also from NH. I


I am also from NH. I looked carefully at the State Board website and didn't find that an MD had to clear the line for use. Are you sure? I know that they need to order a PICC, and an MD or radiologist needs to look at the x-ray and read the results, but I didn't see that he needed to write the order. What we are currently doing is having the radiologist tell the PICC nurse the location of the tip, and if it is in the lower third of the SVC we can clear it for use and write that in our notes. Ladena, the docs usually put "overlying the SVC" and I cannot get them to be more specific in the report. It is apparently a pre-set response. I do usually look at the x-ray with them, so I have a good idea of the location and have them define it specifically for me.

Gail McCarter

Gail McCarter, BSN,CRNI

Franklin, NH

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