Re: Arm measurements

[InfusionTx]

I am with Lynn,   I have never endorsed this policy and still don't for several reasons. First is that it is nearly impossible to get a repetitive and accurate measurement. It has to be measured at the same exact point with the arm and wrist and hand in the same exact position. Then we have to figure in fluid balance and muscle tone and nutritional state. These all could increase the measurement with no catheter complication. But how am I to know if the increase was related to a positive change in patients over all health or a catheter complication. When do I sound the alarm?.   So once you get a measurement what do you do if it changes 0.5 cm or 1 or 2 or whatever. On this list I once ask for any study, guideline, policy, in short anything in writing that said at what change in girth we should consider a pathological problem. No one came forth with anything. I thing that other symptoms will alert us to problems long before a measurement will. Especially measurements done every three days.   What if you did have a complication and a lawyer notices that there was a 0.25 cm increase in girth and you did nothing. They will imply in court you did the measurements because you knew there was a risk and when your monitoring showed a change in the patient condition you failed to act and therefore your negligence led to the patients injury. A stretch true but I could see it happening.   So in my estimation measurements are both a waste of time and a liability to the facility. I believe this habit is based on policies developed when nurses were first placing PICCs. You remember, break away needles, small sterile fields, no gowns or hair cover. It is wonder anyone survived.   Tony West, RN, CRNI Healix, Inc. Email: [EMAIL PROTECTED] or [EMAIL PROTECTED] SMS: [EMAIL PROTECTED] Cell: 214-674-4848   In a message dated 1/11/2006 5:52:27 A.M. Central Standard Time, [EMAIL PROTECTED] writes: I agree, it is a waste of time. Get a baseline before insertion, then when signs and symptoms of complications are present. No studies to support this practice that I have ever seen. Lynn At 1:55 AM -0500 1/11/06, [EMAIL PROTECTED] wrote: Our IVT team measures (both) upper arm circumferences at the time of PICC or midline placement, and also every 3 days.  Most of us look upon the every 3 day measurements of both arms as a waste of valuable nursing time and energy and would like to delete it from our practice.  Are there any studies showing that this is a worthwhile practice?  Or does anyone have any anecdotal evidence that this is a worthwhile practice?  What do you PICC nurse educators recommend?  We're all ears!  Janet Brown-Wise -- Lynn Hadaway, M.Ed., RNC, CRNI Lynn Hadaway Associates, Inc. 126 Main Street, PO Box 10 Milner, GA 30257 http://www.hadawayassociates.com office 770-358-7861