Re: CVC placement question

[Elizabeth Harmon]

Lisa   With the tip in th bracheocephalic approx 1 cm up from the SVC,  this would not be a central line depending on who interpret's it.  My question would be. Is the reason they left it there was because the line would not advance any further?  If so what is it impeeding the advancement and will this cause further problems down the line? Or did they just simply want it that High up above the SVC?  There are multiple position papers as the increased incidence of thrombosis with distal tips above the SVC.  Check out the archives on Distal tip position statement.    The Osmol of your TPN and INS standards could help you alot. If your TPN is greater than 600mmOsml (which most are >1000), than even if you use the distal port you are not in the SVC.  If you used the Medial or Proximal ports you would be even further from the SVC. What are your Central Nursing Policies and Procedures stating for what a RN can use?  The reason I ask is that we had several Physicians that use to leave the distal tips at the head of the clavicle or in the bracheocephalic and our nurses would check out the procedures and state that unless they have a correct position in the SVC they were hard pressed to give the medication or ordered therapy because of the nursing procedures.  Because they made this known,  practices have been seen to change in where the physician has placed the distal tips of CVC's.  We are also a Magnet facility and the whole Interdiciplinary Team (Physician, Intensivist if in CCU, Pharmacy, Dietary, Nursing, Respiratory Therapy, Speech Pathology, Physical Therapy and all others that could be involved) all have a voice in patient care and treatment.     Hope this helps.   Betsy Harmon RN CRNI Alaska Native Medical Center Anchorage, Alaska  [EMAIL PROTECTED]  ----- Original Message ----- From: [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Thursday, April 27, 2006 6:17 AM Subject: CVC placement question I have a question for the group.  A patient has a triple lumen CVC placed in the left IJ.  The tip placement reading is bracheocephalic approx. 1 cm from the SVC.  The surgeon is satisfied with this placement and is starting TPN infusion through this line.  Is the placement sufficient for this therapy?  Thanks for your assistance. Lisa Kasten