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WHAT DOES EACH OF THE MEASUREMENTS TELL ME ABOUT THE PICC?
Total Catheter
measurement is the total length of the catheter (white catheter) inserted in
the patient. External Catheter
measurement is the length of the catheter (white catheter) outside the body.
Tip placement is the location
of the tip when the external catheter remains constant. Arm
Circumference is
the measurement around the arm 3 inches above the insertion site. This is
used to determine if the upper arm is swelling.
WHY DO I NEED TO KNOW MEASUREMENTS ONCE THE PICC IS IN PLACE?
Legally speaking, you should know where the tip of the catheter is when you
use a PICC line. That is why the measurements are important. We tell you
where the tip is relative to the length of the catheter showing on the
outside. Any change in the external measurements leads to change in tip
position. You should not use a line if you do not know where the tip is
located.
WHERE IS THE TIP SUPPOSED TO BE?
According to national guidelines, PICC line tips are to be located in the
superior vena cava, not in the right atrium, not in the subclavian, not
in the innominate (brachial-cephalic) veins.
If not in the superior vena cava, the tip is malpositioned and should be
adjusted. Tips in the subclavian and innominate veins have a
higher possibility
of thrombophlebitis developing. Tips in the atrium can lead to arrythmias.
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When a PICC is placed, superior vena cava placement is the
goal for tip placement. The documentation will indicate what the
measurements are at the time of placement to achieve the correct tip
placement. If the external measurement changes, so does the tip placement.
EXAMPLE:
Total Catheter: 50 cm
External Catheter: 0
cm
Tip Placement:
Superior vena cava
This means that to be sure you still have superior vena
cava placement, the external catheter must remain “0 cm”.
WHAT DO I DO IF THE EXTERNAL CATHETER MEASUREMENT CHANGES?
First let me say, “Do your best to prevent position changes. Keep the
catheter secure by maintaining a clean, secure dressing. Not all PICC lines
are sutured.” Assume that they are not sutured and remove the dressings with
caution, always pulling tape upward and inward toward the catheter.
If part of the catheter is pulled out consult with the PICC nurses. Two or
three cm should not change the position enough to cause a problem. However,
you must consider what is being infused.
REMEMBER: If in doubt of tip position request a Xray for
verification.
National Standards Indicate:
Following therapies should be administered via central tip
placement only: continuous vesicant chemotherapy, parenteral nutrition
formulae exceeding 10% dextrose and/or 5% protein, solutions and/or
medications with pH less than 5 or greater than 9, and solutions and/or
medication with osmolarity greater than 500 mOsm/l.
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