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:
- Absence of blood return from all lumens
- Changes in color and pulsatility of the blood from all lumens
- Difficulty in flushing
- Atrial or ventricular dysrhythmias
- Changes in blood pressure, heart rate, and/or respirations
- Pain, edema, or strange sensations in the shoulder, neck, chest, or back
- Complaints of hearing a running stream or gurgling sound on the side of the CVAD
- Neurological changes, paresthesia