PICC nurses...do you read your own tips

mrsbratmom · Jun 26, 2008

This forum is different than the other public forums I belong to. Lots of views to posts but very little replys. I have a lot of info I could reply to, I was hoping to find some quick answers as I need a general feel of what others do by tomorrow.

iluvivt, BSN, RN · Jun 27, 2008

Hope this is not too late for you. In California nurses that are trained and certified by the procedure set up at their place of employment can verify the course of the PICC line including the tip location. We must set it up as a standardized procedure with annual re-certification (usually a quick test).

If there is any question or doubt about the PICC tip we can re-order a second CXR or send it to a virtual radiologist as it would be unwise to release if not well seen. We do not have a time frame for rad to look at it,though generally it is read within 2-14 hours,depending on the time it was taken. We do not have radiologist past 1730,unless they are called in for a special procedure. We do reconcile our read with theirs to make sure all is OK and make adjustments accordingly.

mrsbratmom · Jun 27, 2008

Thanks for the reply. It does help. Our meeting was rescheduled with the radiologists for a later time. Our new lead of radiology is asking if we can read our own tips without a radiology read at all. We are all balking at this so just trying to see what the standard is out there.

dsnyrn5 · Jun 27, 2008

Hi, We currently do not officially read our picc tip xrays and really do not want that responsibility. We can view them on the computer, but the radiologist is responsible for the results. Our problem is getting them read

mrsbratmom · Jun 28, 2008

Our readiologists are getting annoyed with us as we place our PICC's by flouro and we need a pretty quick read. We are all for reading our own tips to facilitate faster placements. Some days we are placing 6-7 PICC's and need to move along quickly. I just dont want the total responsibility for the read.

iluvivt, BSN, RN · Jun 28, 2008

Just wanted to let you know one more thing before you go to your meeting. You need to check with the Board of Registered Nurses in your state. They will determine what you can and cannot do. Most states have a decision tree on the functions that are gray in nursing. These are areas where nursing and medicine overlap. As far as the radiologist not wanting to read the PICC location AT ALL....quess what....they do not have a choice. That CXR must be read and comments on all things seen in that film must be commented on. What about team work here...thats what you need to tell them. Please remember that if there is a film in which you are unsure about where the tip is you do not read it and let the radiologist to it. I would be happy to send you or E-mail you a copy of our standardized procedure. send private message if interested

jer_sd · Jun 29, 2008

Also what about incidental findngs, pneumo, nodules, ect.. the x-ray should get a final read for liability reasons. It would be a huge problem is cxr was done for tip localizaton but no read and mised lytic lesions in the ribs and you have this wondeful image that will go to court.

Now if the RN is only confirming tip location prior to use and the x-ray is also read and dictated appropriatly the RN should be able to start use of the PICC prior to final reading.

Jeremy

mrsbratmom · Jun 30, 2008

I am thankful for your replies. I am really hoping that our risk managment puts a stop to the radiologists wishes to not read the xrays and that they will work with us to validate us for tip location reads.

JOPICCRN5 · Jul 8, 2008

I always go down to x-ray and read the tip placement with the radiologist. Then if it is malpostioned we can discuss options and I also know what he is looking at. It really helps alot. We have to take a course to be able to read our own tips. But it would be nice to be able to start therapy and not wait. After all I can see if it goes up into IJ or down into SVC and have learned enough standing beside the radiologists to know approximately where my landmarks are and if I am in atrium or lower SVC, but I still would want a radiologist to back it up because even they have been wrong on occasion!

mrsbratmom · Jul 9, 2008

It sounds like you have great radiologists. All our Picc's are placed with flouro so we do not have tips that are malpositioned and we get confirmation right away. We have been to classes on how to read our own tips and have been "reading with the rads" for a long time. They are just not wanting to officially check us off to release our own tips but yet they pitch a fit when we want a "read now"

PMRMD · Aug 24, 2008

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/CVC_AND_PICC_TIP_LOCATION_WITH_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.