Pre-Meeting Workshop

WS4 — Pre-Meeting Workshop: Radiographic Assessment of CVADs

• 

  Jamie Santolucito, RN, CRNI®, VA-BC™

  Clinical Director
  GoldStar Vascular Access

Despite recent advancements in the use of intravascular ECG-guidance as a reliable method to confirm CVAD tip position, basic knowledge and understanding of vascular anatomy as defined by the chest radiograph remains crucial to the specialty practice of vascular access.
This session will address basic fundamentals of chest radiography including radiographic densities, exposure, patient position and rotation, degree of inspiration and search pattern. Contrast-enhanced digital imaging with direct correlation to the frontal chest radiograph will be used to accurately identify relevant structures such as the right and left mediastinal borders, including the right atrial appendage and cavoatrial junction, as well as arterial anatomy and aberrant vasculature. Osseous and airway structures will be defined radiographically as an alternative method to determine optimal CVAD tip location when vascular landmarks are obscured. Numerous cases will be presented and discussed demonstrating optimal, suboptimal and malpositioned CVADs.
Although the majority of radiographic images represent PICCs placed in adults, radiographs of centrally-inserted CVADs and PICCs in pediatric and neonatal patient populations will be included as well.

Learning Objectives:

• 1. Describe basic fundamentals of chest radiography including, radiographic densities, exposure, patient position and rotation, degree of inspiration and proper search pattern.
• 2. Using contrast-enhanced CTs with direct correlation to the frontal chest radiograph, accurately identify the following structures: a. Right and left mediastinal borders, including the right atrial appendage and the cavoatrial junction c. Osseous and airway structures and their relationship to underlying vasculature d. Arterial anatomy e. Select aberrant vasculature
• 3. Describe effective tools and techniques to enhance radiographic assessment of CVADs.
• 4. Review numerous cases demonstrating optimal, suboptimal and malpositioned CVADs.