How often are cxr's obtained on patients that have long-term PICC placement for chemotherapy (PICC dwell time several months)? Also, if a patient goes home and is then readmitted into the hospital is a cxr obtained every time? Just trying to find out everyone's current practice. We cxr every patient admitted with a PICC even if it was placed recently. One of the ER MD's is questioning this practice.
New INS standards will have a new standard on Catheteter Malposition and that document is now in the mail. I can not remember what this standard contains exactly however I would recommend a repeat chest xray when there is any question as to the tip location. This includes complaints of chest pain, ear or neck pain, hearing a running stream, any strange feeling in the chest or neck, inability to flush and/or aspirate blood, etc. I think many hospitals have a policy to repeat a chest xray on admission because there can easily be secondary malposition and because some agencies may still be placing midclavicular tip locations and calling them a PICC. There are no studies that have firmly established a time frame for repeating a chest xray. So basically it is determined by clinical signs and symptoms if you know that the catheter was correctly located upon insertion. Lynn
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
Lynn,
We are alos looking at placement prior to any CT injection as this is also recommendation by Radiologist in 2010.
Thanks Lisa
A very important point!! Thanks for adding this. We will soon have an online CE on Perils of Power Injection that discusses the issue of infusion induced catheter movement. This was a symposium given at AVA last year. Lynn
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
We get a CXR for tip confirmation on every patient being admitted into the hospital with an exsisting PICC.
Regards,
Judy
Hi Judy
Which facility do you work at that have as part of practice/ policy?
We have at ours as well but have been asked what facilities outside of our organization have as well.. So reaching out
Thanks
Erika Anderson RN,
We have it as "highly recommended" upon admission in our policy; we're located in Burlington, VT.
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center