The standards indicate for adult patients, the midline tip should be distal to the axilla but I have seen a variety of locations medial to the axilla in practice. Evidence is rated "V" so this leaves me wondering how critical is midline tip location especially when the midline is a picc pulled back to midline. Also is there a reference showing exactly what "axilla" means anatomically besides the longitudinal ones like anterior axillary, mid-auxiliary, etc.?
Do not confuse the axillary line with the axilla. They are not the same. The axilla is the armpit. The correct midline tip location is now and has always been since they were introduced in 1989, level with the axilla or armpit. Place your fingers in the armpit of the patient and encircle the arm at that level. That is the mildine tip location. There is no other. The axillary line is a vertical line running through the chest. The lateral axillary line would mean that the midline tip would end up in the shoulder area where it is affected by motion of the joint. Do NOT use the axillary line for any midline tip location. 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