Catheter Tip Location & Verification Flashcards

During ECG-guided PICC placement, the P wave becomes biphasic with an initial negative deflection. What does this indicate?

Answer: The tip is in the right atrium and should be withdrawn

A biphasic P wave means the tip has passed the sinoatrial node into the right atrium, so the catheter should be pulled back to maximal P-wave height.

Which ECG finding indicates the tip is at the cavoatrial junction during intracavitary ECG tip confirmation?

Answer: Maximal positive P-wave amplitude without a negative component

The P wave is tallest at the cavoatrial junction, just before it turns biphasic in the right atrium.

Which patient is least suitable for ECG-based tip location as the only method?

Answer: A patient in atrial fibrillation

Atrial fibrillation has no identifiable P waves, so ECG tip guidance cannot be interpreted.

On a chest radiograph, which landmark is commonly used to estimate the cavoatrial junction?

Answer: About 2 vertebral bodies (roughly 4 cm) below the carina

The cavoatrial junction usually lies about 2 vertebral body units below the carina.

A newly placed right-arm PICC has its tip in the right internal jugular vein. Which symptom might the patient report during infusion?

Answer: A gurgling or rushing sound in the ear on the same side

Fluid flowing up into the internal jugular vein can cause an ear-gurgling sound or neck discomfort.

Per INS Standards, what is the recommended tip location for a femorally inserted central catheter in an adult?

Answer: The inferior vena cava above the level of the diaphragm

Femorally inserted CVAD tips should sit in the IVC above the diaphragm.

Before PICC insertion, how is catheter length estimated from the right arm?

Answer: From the insertion site to the sternal notch, then down to the third right intercostal space

External measurement to the sternal notch and then down to the third intercostal space approximates the CAJ.