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Bariatric Patients for PICC


Does anyone know if there is a special sized PICC catheter available for Bariatric patients? I recently had a 600# patient. During my assessment I measured to determine if my 55cm PICC would reach to the SVC area. Due to the girth of the chest I determined the tip wouldn't reach the cavo-atrial junction. So I did not insert it. Has anyone come across this situation and what have you done?

Thank you,


There are brands of PICCs

There are brands of PICCs that are 65 or even 70 cm in length. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Sherry, Don't forget that


Don't forget that underneath all that tissue is likely a typical sized bone structure. Our team is frequently called as a last resort, meaning that the surgeons have tried and failed to place a central line. We place a large number of bariatric PICCs, esp on the traumas. We use the Bard Power Picc and it is 55cm. So far, it has always been long enough. We measure as usual, take into account how long a picc would be on a person of the same height. In my experience, height and limb length are a better indicator for Picc length than weight. Measuring is always difficult when you are measuring tissue instead of bone structure (large breast implants make it hard too).

 Just last week we placed a picc on a patient that had an arm circumference of 55cm and was >600lbs.  Measurements gave an initial measurement of 68cm (WHOA) from the AC. Accessed cephalic vein 5cm above AC, inserted all 55cm and crossed our fingers. Turns out we were waaaay long. RV long. Pt had runs of Vtach when he lifted his arm! True measurement to the SVC/RA junction was more like 45cm. It is always complicated by poor film quailty on the portable xrays too. This particular case resulted in a heated debate with the radiologist. His read was tip location of subclavian (!!). We battled it out and many films later we had good placement.

On average our team feels like out bariatric picc placments always "go long" and we have to pull them back. Our philosophy is better long than short for these difficult placement.




Bariatric PICCs

I think that Martha's comments are right on.  In my experience the extra body mass will affect your PICC length in two ways.  First, you need to add length to compensate for the greater depth of the vein you are accessing; 4-5cm is the deepest vein I have been able to hit, and the insertion site is usually lower down the arm because the veins are too deep higher up.  Other than those two considerations the distances should be the same as a slender person of the same height. 

Jerry Bartholomew RN, MSN, CRNI

VA Medical Center, Spokane, WA

Susan S
Sherry  I agree with the


 I agree with the using the height as a base number and adding for the depth of the vein.  I have placed in many morbidly obese patients, and have found the same thing with measuring too long, then having to pull it out of the atrium.  Another intereting thing I have found that many morbidly obese patients have a HUGE cephalic vein that is much closer to the surface....but then you have that possibliity of it going back down the brachial.


Susan Schuetrumpf, CRNI

Atlanta GA

Susan Schuetrumpf, RN, CRNI, VA-BC
Atlanta GA

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