When should a chest xray be repeated during the dwell time for any central vascular access devices (CVAD)? This is a frequent question for many nurses and facilities and it involves several different scenarios. There is a risk of radiation exposure, albeit small, from a routine chest xray. Reducing their use will reduce this exposure along with decreasing costs. However, there will be clinical situations when the benefits outweigh these risks. When a new patient with a PICC or implanted port is admitted to your facility or agency, the first option is to check documentation of the original tip location at the time of insertion. But there will be many times when this information is not available. Do you know about tip location practices in other facilities or agencies in your area? Some may still be using the old “midclavicular” tip location for PICCs with the inserted catheter length based exclusively on external measurement. Some practitioners may not understand or acknowledge the importance of tip location at the cavoatrial junction, leaving the tip high in the superior vena cava. This means the first reason would be a suboptimal tip location on insertion. The second reason would be clinical signs and symptoms of a malfunction or malposition which can occur at any time for many reasons. Clinical assessment of all CVADs is on ongoing process while the patient is under your care. Signs and symptoms are outlined in an evidence-based list in the 2016 Infusion Therapy Standards of Practice and includes:
3/6/2017 02:07:11 am
Thank you Lynn. This issue generates a lot of questions.
Patricio Collera
3/8/2017 01:15:07 am
If the makers of the 3CG and other tip locators will sell just the wire of the locator, a chest X-ray will be avoided. Common sense will also tell you if the line has migrated out by more than 7 cms from the original placement measurement, there would be no need to waste a chest ray because that tip is for sure out of the Distal SVC. Staff Nurses and physicians should utilize the expertise of their board certified vascular access specialists to help them figure out what is wrong with their vascular access. Comments are closed.
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Author: Lynn HadawayLynn Hadaway is an international thought leader in infusion therapy and vascular access, having been in this practice for more than 40 years. Her experience comes from hospital-based infusion teams, device manufacturers, and continuing education services. Her journal and textbook publications are extensive. She also maintains board certification in infusion nursing (CRNI) and nursing professional development (RN-BC). Categories
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May 2019
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