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Xray's of PICC upon admit

Hello all.

Do any of you have a policy with regards to xraying a pt being admitted with an exsisting PICC?   How about xraying long term PICC pt's every so often to check for tip placement?

I would really appretiate examples if possible, you can email me privately.   [email protected].

Thanks in advance.


What reason would you have

What reason would you have for doing that?


To check for PICC tip migration.   We have had many instances lately were we "accidently" found out a PICC tip had migrated into the jugular after weeks of cavoatrial jucntion placement.

It is in the INS standards to follow this procedure "according to institutional policies and procedure"....but we do not have such policies in place.    

Lisa Y., RN, BSN University of Pittsburgh Medical Center/Horizon IV Therapy

A good idea
A few months ago, we had this discussion at our local INS chapter. The concensus was that a CVC of all types should be xrayed when the patient is admitted to the hospital. The tip location needs to be confirmed to rule out migration and dislodgment. Plus there are some people still using the midclavicular tip location and this needs to be ruled out as well before anything is infused. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Is there data to support

Is there data to support this, or just opinion?


jung yae kim
x-ray's of PICC upon admit
Whenver patients are admitted to our hospital with existing PICCs, we automatically x-ray them before we start using to confirm the tip placement. We  utilize our pre-printed order sheet of the  post insertion of PICC line   to order x-ray of PICC upon admission.
Many occasions, we have found  PICCs  in the IJs, innominate veins, or even in the RAs on admitting x-ray. Whenever those things  happen, we feel  much relieved that we have done x-ray before we use them, especially for chemos, HA or any vesicants.
Michael Drafz
We assess all incoming

We assess all incoming Picc's within 24 hours. If line was not placed in our health system, and there is no recent (less than a week)documentation (xray report) of appropriate tip position on the chart, we will get a cxr. On lines we placed, we assess blood return, external catheter length ect. unless pt. has been home for a while and there is no recent xray.

If we are in doubt we get an xray.

We do not have this as a policy, but as a department guideline of care.

Michael Drafz RN, CRNI, VA-BC

Clinical Lead Vascular Access Service

Sharp Metropolitan Medical Campus

San Diego, CA


Heather Nichols
I am currently trying to put

I am currently trying to put a policy in place for this, but it is to include ANY patient that has any type of central line coming in as a new admit.  It does not matter if we previously placed the line or someone else.  Does anyone have a policy already written and in effect that they would be willing to share with me?  Thanks ahead for any help.



Dianne Sim RN VA-BC
 Over the years, in many

 Over the years, in many different settings, we have observed PICC tips that have malpositioned to multiple sites, at varying intervals from time of insertion. From a risk management point of view, I believe regular CXRs are required to confirm appropriate placement, particularly prior to infusion of a vesicant. These malpositions are often asymptomatic, and occasionally have good healthy blood returns (meaning that the PICC is in a vein, just not necessarily the right one!!!)

Dianne Sim RN

CEO & President,

IV Assist, Inc

Dianne Sim RN, VA-BC, CEO; IV Assist, Inc.

So I gather that there is no

So I gather that there is no data about this.

If I were definitely a

If I were definitely a hospital I would have a policy in place to check tip positiion of all central lines that are admitted before use - patient safety is the pecedent.  You do not need a guideline or article to suggest that this should be standard policy

There are plenty of tips not where they are supposed to be and homecare/hospitals still place midclavicular PICC line often

Kathy Kokotis

Bard Access Systems

Julie Mijatovich
Everyone addressed PICC's,

Everyone addressed PICC's, but what about Long term lines ie Hickmans etc.

ONS guidelines are recommending rexray every 3 months and our CNS is pushing us to put this into policies and procedures, but INS does not recommend this standard.

What is everyone else doing with long term lines?  Please do respond, I do need an answer asap.


Julie Mijatovich

Fort Wayne, In

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