Forum topic

4 posts / 0 new
Last post
Tracy Snashall
measurement of PICC external length / arm circumference
I work for a home infusion company and there is always a debate over weekly measurements of PICC external length / arm circumference.  First of all, are others doing these measurements on a weekly basis.  Second, the PICC 's we see most in the home are Bard Groshong, and everyone measures external length differently.  Do you measure from the hub to insertion site, or from the 45cm mark on the PICC itself (but there is some additional catheter showing beyond that 45cm mark) which makes this even more confusing ??  Any feedback would be appreciated. 
lynncrni
You definitely should be

You definitely should be measuring external length with each dressing change and comparing this to the original length left at insertion. If this external length has changed, then your tip location has also changed and you will need further assessment about what to do with that catheter. There are no guidelines about how you measure because each brand of catheter has different configurations. But you need to establish a standardized way of doing this so all nurses are measuring the same way.

RE arm circumference measurement, the INS standards now say that you should get a baseline measurement and then only measure again when there is a problem. Regular measurement is not necessary because there is so many variations in measuring technique.  

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

momdogz
For our original and then

For our original and then weekly assessments, we document what the catheter is inserted TO, i.e.: what the cm mark is at the insertion site.  There's then no debate about it.  If for some reason an IV RN wants to document the external length (see later paragraph), we measure to the last mark: i.e. what the manufacturer actually states the length of the catheter is.  We keep this consistent for the sake of outpatient clinics and home health staff that also change PICC dressings.

If we inserted a DL 45cm Groshong catheter 41cm, then the 41cm mark would be at the insertion site, and we document "catheter inserted to 41cm".  If we wanted to document the external length for some reason, the external length of the catheter in this instance would be 4cm.

If someone else then instead measures to the hub, there's usually only about 1 1 1/2 cm extra, not enough to make a difference trying to figure out if it has migrated or not.  If there is a lot of concern about 1cm migration in any particular case, use the cm mark on the catheter method - it's a lot more accurate.

We educate the inpatient staff nurses to measure external catheter length from outside the dressing, and we tell them to measure (to the best of their ability) from the insertion site to the junction of the catheter to the suture wing.  If their measurement is 1-2cm off of the original insertion measurement - they don't contact us unless they have a concern. If it's 3-4cm more different, they contact us and we'll assess.  Otherwise, the assessment for migration by IV staff occurs on a weekly basis when we do the dressing changes.

We catch actual migrations earlier now that the unit staff are required to measure for catheter migration at the beginning of their shift, with a relative assessment prior to every use of the catheter.  They are also required to measure subclavians and IJs. 

Re: MAC:  We measure prior to insertion, and when there is a problem. 

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

lynncrni
The process Mari described

The process Mari described is a good one. The only thing I would add is that there are no standard FDA requirements about catheter markings. Some begin with the small numbers at the internal tip and some begin at the external side. Some mark every 5 cm and some every 10 or even 1 cm. You just need to figure out what works for the brand of catheter being used with regard to the markings.  

 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Log in or register to post comments