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We do the same and use a 3" from the AC as a point
of reference as we use ultra sound for essentially all of our PICC
insertions.
Lilia Mullins, RN, CRNI
Swedish Medical Center
Seattle, WA
----- Original Message -----
Sent: Sunday, February 12, 2006 4:30
AM
Subject: Re: Arm measurements
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
>
>
>
>
>
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