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jadahl
xray confirmation on existing PICCS
What are other insitiutions doing on x-ray confirmation for patients admitted with PICC's?  We currently x-ray only if they are questionable, but I'm wondering if we should be checking all.  Are other doing the same, x-raying all admits with PICC's, or x-raying only those PICC's you have not put in or cannot verify measurements for?  Thank you - Jane IVT Salem Hospital.  Salem Oregon
ckcrnipicc
Our policy is to x-ray and
Our policy is to x-ray and obtain a tip confirmation and notify the PICC team if a patient is admeitted with a line.  We are not allowed to call the line a PICC till the tip is verified to be in the correct position.  Have seen patients discharged to a SNIF and come back within the same week and now the PICC we placed for discharge is a Midline - of the same brand and was not distinguishable without an x-ray.  We also had patients that had PICCs that were once SVC up the neck.   
lynncrni
A discussion at a local INS
A discussion at a local INS chapter in Atlanta about this topic showed that the majority of hospital nurses had a policy that all central lines were xrayed on admission to determine the current tip location. So this should not be limited to PICCs, but include all types of CVCs. 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

momdogz
We do xray incoming pt.'s
We do xray incoming pt.'s with existing CVC's.  And.... sometimes we can reasonably save the pt. an extra CXR.  If the PICC was placed by us, the IV team, we will assess the PICC - dressing, site, and length still inserted, comparing it to our data.  If there is a change in insertion length, we'll discuss with the MD and radiologist.  The radiologist can pull up the insertion CXR, and with our discrepancy data in cm's can determine where the tip is by measuring, and save the pt. a CXR.  If the patient has been out of the facility for more than 2-3 weeks, or there is other pertinent clinical information - a CXR is still a good idea.  

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

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