Questions & Answers

A question arose today in PACU regarding verification of correct IJ central line placement post PVI. No post-op note had been written regarding the placement of a line and therefore a CXR had been taken in PACU. Unfortunately, there was no Cardiology MD available to view the xray and hence the RN was uneasy at using the line.

I referred to Jen Kirkland RN (Arrythmia Services,) who had given PACU a PVI in service last winter, and who will hopefully be able to repeat it soon.

Here is her response: (and Thank-you Delia for posing the question!)

Hi Ramona,
These procedures are done under constant X-Ray. The only difference is there isn't an EPR copy of the X Ray record. There is a centrally located copy of these films in the Xcelera system based in the cath lab. These films are retrievable by HFN or name.
I would suggest, if there is NO note of potential hemo/pneumothorax in the procedural note, that the nurse/MD, use the stethescope available to listen to breath sounds. If they are diminished over the right upper lobes and there is downward trend of SaO2's, persue the CXR method. You have to imagine that this IJ line has probably been in place for approximately 3-4 hours. Sat's/VS have been followed by anesthesia during this time. Patients have been heparinized, which will excellerate the risk/presentation of a hemo/pneumo.
I think we definitely need to have an inservice to explain the basics of what we do. Could you post the basics of this email for those who don't have access to email. I hope to be able to help you but am waiting to hear back from my new boss. I'll copy Dr. Crystal to see if he has any other advice.
Best of luck,
Jen

Late Entry: A post procedure note must be written by the physician stating that the central line is the correct position and safe to use. There will be an inservice in the next few weeks with Jen and Dr. Crystal. Have your questions ready!