Re: CXR for new admit with central line

[KTMOHN]

Heather-Most of the  hospitals here in Las Vegas are not allowed per facility policy to use a central venous line received from the outside on any patient until a chest xray has been done and the report has been dictated.  Our State Board of Nursing has now allowed that Nurses can view the xray on patients they  on whom have just placed a PICC. Only one hospital has implemented this program.  The Radiologist is named in the protocol order  for the specific device the patient has in one facility.  We too, have had problems with ports being frequently malpositioned and that is what led to this protocol regarding central lines received from outside the facility.  It doesn't matter how long the patient has been out of the facility-he still gets xray'd-BEFORE the central venous device is used.  In one facility they have a set of orders for each central line and the first item in the order is a chest xray to validate tip position.  There are two pieces of guidance offered in INS  Standard #45-although this standard deals with catheter placement-the standard is on point with your question-"...Central catheter tip location shall be determined radiographically and documented prior to initiation of the prescribed therapy...."  and additionally  "...If the patient is receiving long-term or chronic therapies, repeat radiographic study should be performed to confirm catheter tip location, according to organizational policies and procedures..."  I would imagine your risk manager could help the facility how much risk they are willing to assume for a malpositioned device.  This is a dicey thing because I would think the Nurse herself would bear some liability in the instance of a malpositioned device based on this standard-since she should know the tip position is appropriate before initiating therapy.  Thank you for this question-this gives me more ammunition to quiz the State Board! Your question ought to raise some lively discussion-Kathy Mohn-Greetings from Las Vegas