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Xray Settings and Technique
Could some of you share your tricks of the trade when ordering or suggesting XRAY settings for adult patients?  Large Obese patients are especially challenging sometimes but we also see poorly visualized PICC lines on normal sized patients occasionally.  I know Bard recommends the following:

Adult: A 14 x 14 shoulder view is used with a Bucky tray and grid. A MR-400 screen is used and the KV is increased by 5-10 KV over the normal shoulder technique. Visualization is further enhanced by the use of a 10-15 degree oblique angle other than the anterior-posterior view.

Have any of you found other techniques to be effective?
Rich Lewis, RN

Rich Lewis, RN

Whenever possible, avoid

Whenever possible, avoid portable.  PA is better than AP. 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

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

Alma Kooistra
We have occasionally used an

We have occasionally used an RPO (Right Posterior Oblique) view of the chest.  This allows the PICC to superimpose itself over the left lung and can be helpful. 

Also, our rad techs now routinely send over a 'line enhanced' view in addition to the regular view of the chest.  This has nearly eliminated our need to do the RPO pictures. 

A bit of contrast media injected into the line can also help if you're having trouble seeing it.  We get a physician's order and inject, then remove the contrast as soon as the picture is taken.

I hope this helps......

Alma K.

Thanks to the responders for

Thanks to the responders for the comments.  Unfortunately leaving the wire in isn't practical in most of the SNF cases. but I am interested in the "line enhanced" view.  Exactly what are you referring to?  Is that the oblique or some special settings?

 Rich Lewis, RN

Sometimes on an obese
Sometimes on an obese patient we'll leave tha quidewire in until the xray is shot.  Our x-ray are usu done within a few minutes, then we remove the wire.  This is vey helpful.
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