Peripherally Inserted Central Catheters (PICCs) can be inserted by qualified registered nurses and since PICCs are central lines, the distal tip placement must be verified by chest x-ray and read by a physician prior to its use. Qualified RN’s have been placing PICCs since the early 80’s. Recently in certain parts of the country, their role have expanded into viewing chest x-rays for the determination of tip position after insertion and releasing the PICC for use. There are several reasons for the role expansion, one of which is the delay in treatment initiation after insertion from the delay in interpretation of the chest x-ray by a radiologist. This role expansion has prompted many questions from healthcare facilities, PICC nurses and the individual state boards of nursing. While a few qualified PICC nurses have successfully incorporated this role expansion into their practice, still many are hesitant and cautious about the legal implications.
There is no doubt that registered nurses can be trained to view a chest x-ray for distal tip placement after PICC insertion. In an expanded role such as this one, it is prudent to check with the state board of nursing to determine if performing this function is within our scope of practice. If there are no state guidelines yet an employer requires the RN to perform this function, it is then the responsibility of the employer to provide education and training along with policies and procedures.
The Infusion Nurses Society has recently released a position statement on the role of the Registered Nurse in Determining Distal Tip Placement of Peripherally Inserted Central Catheters by Chest Radiograph. It is the position of the Infusion Nurses Society that a qualified registered nurse may determine the distal tip location of peripherally inserted central catheters by initial or repeat chest radiograph studies prior to administration of the prescribed therapy. It is the responsibility of the organization to determine its own criteria for allowing RNs to perform this function. This statement is specific to the RN determining the location of the distal tip of the PICC only and does not extend to interpretation of radiographs for any other purpose. It is strongly recommended that chest radiographs viewed by a qualified RN be followed by a physician’s final view and report.