Hello all.
Do any of you have a policy with regards to xraying a pt being admitted with an exsisting PICC? Â 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. Â [email protected].
Thanks in advance.
Lisa
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
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Is there data to support this, or just opinion?
Tim
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
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.
Heather
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 data about this.
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
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.
thanks,
Julie Mijatovich
Fort Wayne, In