We do a baseline arm circumference when we place the line and then only repeat the measurement if there is patient complaint or visible swelling later. This has worked well for us.
Alma Kooistra RN, CRNI
From: "sharon symons" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
Subject: Re: Arm measurements
Date: Sat, 11 Feb 2006 18:33:32 -0800
I have arm measurement on my preprinted notes and have been consistenly "bad" at either measuring or recording this. I also have had home health companies call me to ask for this measurement. Can I dump this from my records/practise or is a baseline measurement a standard of practise?
resending ... ment to send to all
>From: [EMAIL PROTECTED]
>To: [EMAIL PROTECTED]
>Subject: Re: Arm measurements
>Date: Wed, 11 Jan 2006 23:06:55 EST
>
>
>
>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
>
>
>
>
>
