Does anyone have a policy regarding the floor nurses having to document daily in their assessments the external length of a PICC? I have only found literature stating that the external length is documented at the time of insertion and when the dressing is changed by the staff nurse or IV nurse.
I do not see how a staff nurse can possibly document the external length without removing the dressing and the method of securement. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hi-
just curios what the practice is out there. As a bedside RN Iwas accustomed to documenting external PICC lengths whenever possible. It is easily visualized with a statlock and tegaderm dressing. The hash marks were often face up and could be easily read, and if not a measuring tape could be used. This certainly did not require the removal of any dressing.
I found the following thread that sums up my concerns as a practitioner. Why, is possible would we not encourage those at the bedside to include this information, if readily available, in their assessment. I have seen tragic effects such as this RN noted in her post.
Old post...
"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 RN
Nurse Educator IV Therapy/Vascular Access Fletcher Allen Health Care
Per Diem Educator, Bard Access Systems"
I look forward to your responses.