PICC nurses...do you read your own tips

I thought I would mention another way to do tip location in real time - ECG guidance. The principal is that an ECG can be derived from the guide wire of the CVC and the P wave dramatically changes as you get within about 4 cm of the SVC - right atrial junction (see http://www.pacerview.com/index_files..._PACERVIEW.htm). As you'll see from the tracings there, the changes in the P wave are not subtle. The technique is well established (numerous references are cited on the same web site) and accurate, less expensive and less time consuming than x-ray, and a recording of the ECG transitions can be your documentation.

Im just curious reading this as we might look at the possibility of the PICC nurses providing a initial read of the xray and the radiologist will read it at a later time (hours later) to confirm tip placement.

Does anyone know if the Infusion Nurses Society addresses this within their practice? Does anyone have a policy that they might like to share that allows this and what do you do for competency for the RN who will be providing the initial read.

You can PM me if you'd like.

THanks

Interesting thread. I have nothing to add as a student nurse, except that I am a little surprised at how quickly the radiation folks are willing to give up part of their scope of practice to nursing. If I were them, I would hold on to that technological advantage over other professions like grim death. More for us, I guess....

I am an Vascular Access Nurse in the State of OHIO, our state board does not let us sign off the PICCs because an RN in the state of Ohio is not allowed to read x-rays. However, we do look at the x-ray before we send it to the radiologist. Once it goes to the radiologst he/she reads it immediately and signs off on the PICC. We do all but our ICU patients in a special room for PICC insertion and we will not sand a patient back to their room with a PICC that can not be used.

I was at the last two INS national meetings and both times they had lectures on reading tip placement. So, yes the INS as well as AVA supports nurses reading for tip placement, but it all depends on the state that you live in.