to measure,
basilic/brachial vein route: AC to right below the
collarbone, then straight down to 3rd intercostal
space (nipple line for small sized kids).
cephalic route: add 2-3 cm (cephalic measurement is
tricky. hard to describe with words).
when access of the vein obtained, minus the distant
from the exit site to AC.
for example, for a medium sized adult, 45cm is from
right AC to SVC, if the exit site is 3 cm above AC,
internal length is 42 cm + skin depth.

this is also one of the reasons to review all picc CXR
you place -- after seeing how those catheters
turn/route to SVC, you can pretty much measure
blindly.

--- [EMAIL PROTECTED] wrote:

> Since we have been having this long and interesting
> discussion of tip placement for the past week I
> thought it might be a good opportunity for those of
> you that insert PICCs blindly at the bedside either
> with or witout benefit of US/MST but NO flouro to
> please describe how you MEASURE (excluding those
> that use Nurse Lums method)--We have experienced a
> rash of MISmeasurements lately--Ranging from 4-5cms
> too short to 4-5cms too long--Perhaps there are some
> web addresses you can reference that have
> diagrams--Most greatful as always for your guidance 
> 
> --
> Robbin K. George RN 
> Vascular Access Resource 
> Alexandria Hospital Virginia 
> 
> 
> What exactly is the anatomical location of "fine" or
> "okay to use"? This is the question I have asked
> doctors who have pronounced one of these terms to be
> the tip termination of a PICC. I had one radiologist
> who sent (via his tech) me the message that tip
> termination was fine. It took several hours to
> validate what he meant, which was RA. Fine to him,
> not to me, as I cannot leave it there as he could
> have. Some docs think brachiocephalic is fine. You
> are correct - you need to get the exact tip
> termination from them. 
> Leigh Ann


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