My experience is that an increased upper arm measurement is usually a late sign of thrombus. I often notice forearm swelling ;ong before it extends to the upper arm. We changed our practice years ago (when doing AC sticks) to measure at the site. Now that more often correlates to the mid arm and is probably just as useless. More inportant to me is noting any preexisting edema in the both arms and watching for changes. It's easy to miss an edematous hand when only looking at the mid arm.
Darilyn
Vickey Garrett CRNI <[EMAIL PROTECTED]> wrote:
Vickey Garrett CRNI <[EMAIL PROTECTED]> wrote:
We measure baseline and if any complications arise.I agree this is not accurate and other S/S should be taken.When in doubt ask for an ultrasound to R/O DVT.I would get the every 3 day measurements dropped from your work load I think it is a waste of time.
>>> "sharon symons" <[EMAIL PROTECTED]>02/11/06 9:33 PM >>>
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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