PICC Conundrum

I work as a Home IV nurse as well as on a Hospital IV team. I frequently find that my home care patients are discharged without any information on the PICC ie length & tip location.

I have been careful not to initiate home IV therapy until I have verified tip placement with the hospital. I do this because occasionally I come across a line that wasn't x-rayed, I also have found lines that were x-rayed but the tip is in the atrium and no intervention was done. However, I recently was pressured by my supervisor that I need not insist on verification at home because if therapy was initiated in the hospital they would have checked placement, and the standard is to check placement prior to initiating therapy or if malposition is suspected.

I disagree with her rationale. I personally know of nurses who have no clue that placement must be verified prior to use. They ASSUME placement is correct when the patient returns form the procedure. I am not willing to risk my career on a misplaced tip.

Another part of the issue is what therapy is being given. If it is an irritant not a vesicant, or just long term therapy, how much does it matter? ie line does not need to be a CVC, midline would be appropriate.

Please give me your thoughts on the issue. I am seriously considering leaving home care because I feel a lack of support, and am put in situations I feel put patients at risk.

P.S. anyone who knows of any articles on this issue please let me know.