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
