Do you document what the vein size when you evaluate the vein size before PICC insertion? I know that many do evaluate the vein size before inserting larger PICCs, but I haven't seen if anyone documents that part of their assessment. If you do, do you document the size without the tourniquet?
Gwen Irwin
Austin, Texas
We do document, and always measure without a tourniquet - with the vein in a resting state (as it will generally be after the PICC insertion). This information is relative - when you assess the length of the vein up the arm you can see that there is some variability (sometimes a lot - could be other issues) in vessel size, but the smallest diameter measurement proximal to your insertion site will help you make a decision about what size catheter to place.
Documenting this information has also helped us when looking back in the patient record to find out why the nurse chose that size catheter. I think it also demonstrates that a thoughtful/thorough pre-placement evaluation was performed prior to PICC placement; that the nurse didn't place the PICC just because the provider ordered it.
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
we document this as well for much of the same reasons Mari chooses to do so.