When placing PICC lines we measure "arm circumference". We were taught to do it 10 cms below the AC. Merging with other hospitals as we have, and asking where they measure I have gotten answers such as...at the insertion site, 10 cms above AC, and 13 cms above AC. Our policy simply states measure arm circumference with no parameters. The clinical specialist for the PICCs does not have a comment, just says its hospital discretion. If we are going to be consistent do you have a reccomendation as to the best measurement spot??
INS Standards for insertion is measure 10 cm above ACF at baseline and when clinically indicated. NO need for regular or routine measurements. 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
Thanks.
I would ask you to think about that question a bit. Patients in hospitals that develop swelling to an arm with a PICC rarely if ever ask...what was the arm diameter?....they order a US of the upper extremety. Very rarely is that measurement ever used. In the 90's in home infusion it seemed more revelent but nowadays, not so much. But yes, our documentation asks for a extremety diameter also.
Our facility's PICC packet has a spot where we designate where our mesurment is taken at time of insertion. We, the PICC team have decided to measure at the insertion sight. I have observed swelling to begin below the insertion sight, at or below the elbow. we have a Documentation Tool page where, each shift is supposed to ascess the sight, aspriate and flush the PICC (all ports) and measure the arm circumference. If there is a 2cm difference (larger) or more, they are to call the ordering physician, I do believe this catches the possible thrombus sooner. I also believe that consistancy is the gratest importance of all.
Erik Ullmark R.T.(R)(VI)(ARRT)