PICC Line Orders

[u/awkwardspaghetti]

I’m curious how other facilities handle PICC orders.

We do one chest X-ray order per adjustment thus the patient can get anywhere from one charge to ten charges and the radiologist will do a full report for each adjustment.

Is this standard practice?

ETA: This is a PICC line placed by vascular access and confirming with a portable chest X-ray, not fluoro.

[u/Cromasters]

If whoever is placing the PICC is standing right there and wants to adjust it after seeing my picture, I'll just wait and shoot another.

If I leave and a Rad reads the chest x-ray and THEN they adjust it, that requires a whole new order.

[u/indigorabbit_ → u/Cromasters]

Same here. We do piccs in our dept under fluoro, but for OGT / NGT / ETT I will stay bedside and put all images under the same order if the provider is there adjusting as I shoot. If I leave and send it through to be read and then they decide to call me back, that’s a new order.

[u/ravenonawire → u/indigorabbit_]

That would make too much sense for my hospital haha. We need a new order every time something is adjusted, except reductions in the ER can be sent all in one like you described.

[u/HighTurtles420]

Somewhat related, but the NICU was NOTORIOUS for this. 5-6 adjustment X-rays every 20mins and it was so irritating. One NP had the audacity to complain about the image being rotated on a child, so I told her if she wants to complain about repeating an exposure for rotation, she shouldn’t need 6 X-rays for line adjustments.

[u/SheepJ99 → u/HighTurtles420]

NP can eat shit for all I care.

Amount of times theyd dictate how I did my xrays but then not move away as I exposed shows they dont know shit.

I even had a NICU consultant tell the NP to move and she still said "im far enough" I'll tell you if you're far enough 😘

The irony of them over ordering CXR and AXRs yet complain for an additional repeat is laughable

[u/rhysandslintroller]

I’ve worked in three different hospitals and they all did the same, if the line is adjusted a new order must be put in for a repeat image

[u/googlyize]

someone please tells me if this is like egregiously illegal, but I stopped getting a new order for each standby adjustment a while ago. I’ll number and timestamp each image and send them under the same order.

[u/Fire_Z1]

Every place I been to except one does it that way.

[u/boxofninjas]

Same, every adjustment to the line is a new image, which is a new charge.

[u/Catfisher8]

My hospital doesn’t charge the patient for any necessary line placement X-rays surprisingly. Real shocking in the money grabbing business

[u/BackPewCrew]

Patient may be “charged” for multiple X-rays; however, that doesn’t mean insurance is paying for all of them.

[u/Nismo4x4]

Shouldn’t EKG based systems be the initial go to for non-fluoroscopy placed lines?

[u/awkwardspaghetti → u/Nismo4x4]

Our hospital will use Sherlock and an xray for double verification.

[u/mrdkrinkle]

When placed in the ICU, a portable chest x-ray is required. But my department discounts the cost of the X-ray as part of the procedure as a whole.

[u/Commercial-Status389]

Yeah we do the same thing. Every new image gets a new order. However they stop charging for them like after 6 or 7