Admission Chest X-rays What is the policy at your hospital for patients that are admitted with some type of central vascular access device? Is a chest x-ray obtained to confirm the tip location of the CVAD upon admission? Many hospitals have such a policy but many others question its usefulness. There can be several risk factors to think about. The original catheter tip location may not have been in the optimal location. Many practitioners may not realize the importance of placing the tip at the cavo-atrial junction and leave the catheter tip too high in the superior vena cava. This could mean a great risk of tip migration to other veins. Or some facilities may still use the old "midclavicular" tip location without realizing the associated risk. CVAD tip migration can occur from changes in the intrathoracic venous pressure resulting from lifting heavy objects, coughing, vomiting, or the presence of congestive heart failure. Tip migration occurs spontaneously and sporadically. So there is no recommended time interval for a repeat chest x-ray. The policy of confirming tip location upon admission enhances patient safety by providing the knowledge of the current tip location before beginning infusion of any prescribed fluids or medications. All nurses should be alert to the signs and symptoms of tip migration including lack of blood return, resistance to flushing, complaints of unusual pain or discomfort in the chest or neck area, and complaints of hearing a running stream or gurgling sound. An admission chest x-ray provides this information about tip location but all nurses should be alert to complaints suggesting that the tip is no longer in the original and correct location. Protect your patients from the risk associated with tip migration such as vein thrombosis, vessel erosion and infiltration, and neurological problems associated with retrograde flow of infusing fluids into the intracranial venous sinuses.
Posted on: Fri, 06 Sep 2013 16:55:40 +0000
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