Forum topic

Dr. Nifong's and Cheryl Kelley's Power Point presented at the AVA conference in Savannah titled "Nurse and Physician Strategies to Prevent Venous Thrombosis in Clinical Practice" reference importance of vessel size to catheter size. Non reverse taper or reverse taper designs still require a thorough vessel assessment including diameter (without tourniquet). Not sure you will find a regulatory requirement for vessel size documentation, however, recording the ultrasound view by printing or USB drive are alternatives to a narrative note. Important to remember the vessel insertion site is the narrowest diameter where the catheter will lie. My own clinical experience resulted a progression in documentation to include vein diameter, vein depth, and if indicated the reverse taper to allow maximum blood flow around the catheter. It is all about maximizing blood flow and preventing post insertion complications. I would rather review my documentation with vessel size recorded than not if ever required.

Hope this helps.

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

Florida Division

There are no current standards or guidelines that require this documentation of vessel size or depth. The reason for this lack of guidelines is an absence of this information in the published literature - no evidence to base this new guideline upon. However this will be changing as Dr. Nifong is in the process of submitting his work for publication.  The publications process takes time to complete, so you might not see this very soon. But that does not mean that you should ignore these facts on your current documentation. We have never had technology that would allow these measurements before the ultrasound machines. So take advantage of that information and make it work to your advantage now as Tim said. I would rather review a case with this data than without. Trust me, there are so many important facts not documented in the cases I see now, it is frightening! So protect yourself with great documentation anyway you can.

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

www.hadawayassociates.com

PICC insertion is an invasive procedure that has real risks for serious negative outcomes.  Two of those are phlebitis and (clinical) thrombus.  Our industry may not have data or professional guidelines to explicitly support this practice, but we do have physiology and physics to make best practice decisions with - Triad of Virchow, and patient related factors that may make some people more prone to these types of complications than others.

You want to be sure you're not trying to put a 6 French catheter in a 2.5mm vein in a pregnant woman, or person with inflammatory bowel disease, or a person with lupus....or....if you can avoid it.  If you didn't measure the vein, are you sure you would know?  You could probably guess or estimate, but I don't think guessing and estimating hold up real well in clinical practice.  To me, it would be like documenting someone's fever by writing that their head felt warm.

I agree with Tim and Lynn.  I've done a lot of f/u reviews on all sorts of vascular access issues, and it's really frustrating to try to piece things together with incomplete documentation.  Did the clinician try to provide the patient with safe care, or did they just 'stick the line in'?

I consider measuring vein depth and diameter part of a thorough preplacement evaluation, along with checking for WBC trends/shifts to the left, assessing length of vein for narrowing, widening, lack of compressibility, etc. 

It's so easy to document this information.  Document, document, document. 

Mari Cordes, BS RN