At our facility - we place the Solo Power PICC. The catheter is 55cm (per the hash marks on the PICC and documentation on the product label). Some of our nurses are documenting the length of the PICC at 56 cm (measuring from the end of the PICC to the valve on the PICC). I don't think we should not be documenting the 1 cm that is behind the zero mark. Wondering what others are doing - Thanks for any input
There are 2 measurements of all catheter lengths, regardless of the brand. The effective catheter length is the length that is intended to be placed into the vein. The total catheter length is the entire catheter including effective length, extension legs or pigtails, and hubs. Infusion Nursing Standards of Practice call for documenting the total effective catheter length inserted and the amount left external. For instance, if the total effective length is 55 cm and you trimmed 10 cm then placed 42 into the vein and left 3 cm external, all of that information should be documented. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
the extra catheter past the 0 mark. When the person removing the PICC looks at the tip of the catheter (as they should be), they'll see the 5cm marker numbers increasing to the terminal end of the PICC. Looking at those cm hash marks, the removal clinician can determine exactly what the trim length of the catheter is (we custom fit our Solo PICCs by trimming, and rarely do we place one in a patient that is 55 cm long (i.e. untrimmed).
I agree with Lynn about being required to regularly measure exposed catheter length. An extreme case in point - a few years ago I was paged to do a subclavian line dressing change because it kept getting wet. When I arrived at the pt.'s door, I could see right away that most of the catheter was external, even to the dressing. It was so obvious the nurse should have noticed, but even if she hadn't - had they been assessing exposed catheter length, they might have caught it (the MD placed lines usually are inserted to the hub - exposed catheter length is zero). I immediately stopped the infusion. The catheter tip was only 1-2 cm under the patient's skin.
This patient also had significant edema of the chest and neck, and received a nice infusion of TPN and lipids into their subcutaneous tissue.
Most migration malpositions aren't that extreme and are usually at least still within a vein, but can be as disastrous.
Our policy instructs the staff RNs to assess for exposed catheter length before they use any CVAD, and document every shift, compared to initial insertion record. Because they will be measuring over the dressing, we teach them to measure the actual catheter from insertion site right up to the junction of the bifurcation/trifurcation (if triple lumen)darker purple fitting. We tell them that their measurement will be 1-2 cm different than the original, and that any migration that is greater than 1-2 cm, they should contact us to assess and problem solve.
We've been able to intervene successfully to prevent bad pt. outcomes, as long as the staff remember to document this in the electronic health record. (That's another issue.)
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center