PICCs in Right Atrium for TPN
I am a doctor in Australia who has encountered a strange local deviation from best practice guidelines in the hospital I work in. For context, in our hospital all TPN orders outside ICU must be run past our Gastro team for approval, however that isn't the interesting part. The interesting part is that the Gastro team looks at the location of the PICC on the CXR prior to approval and will not approve TPN unless the PICC line is well into the right atrium, approximately halfway into the atrium. A tip at the CAJ is considered too proximal.
While I understand that they might justify this by saying it ensures the rapid dispersal of the hyperosmolar TPN solution, surely the risk of tachyarrhythmias and damage to the heart supersedes this benefit?
Anyway since I don't have cardiologists on speed dial so I wanted to get a cardiology perspective on this here?