In my experience, anything that is based on patient stature is just a good estimate. On the other hand, my external body measurements (up the arm, across the chest, etc) are just a good estimate too. The problem with line measurement based on stature is that is doesn't take into consideration the barrel chested individual who is only maybe 5' 9" but has a very broad chest. On the other hand, a narrow shouldered female who may be the same height could need a much shorter line. I just measure and give a good guess. Most of the time I'm right......
I put 60 cm of PICC into a patient who is 5'9" last week, and it only made it to the junction of the innominate vein and SVC. It was as much line as I had......... He was a paraplegic who had a huge upper body size.
Alma Kooistra RN, CRNI
From: Lynn Hadaway <[EMAIL PROTECTED]>
Reply-To: [EMAIL PROTECTED]
To: [EMAIL PROTECTED], [EMAIL PROTECTED], [EMAIL PROTECTED], [EMAIL PROTECTED], [EMAIL PROTECTED]
Subject: [vascular] Re: PICC tip placement
Date: Sun, 12 Mar 2006 16:47:27 -0500
The traditional measurement process is to use a tape measure and begin at the insertion site, place the tape along with anticipated venous pathway (basilic vs cephalic), turn the tape at the lateral edge of the chest and follow the vein pathway to the right head of the clavicle, turn the tape again and measure to the 3rd intercostal space after palpating the ribs. There is lots of room for error with this method, but it was the best we had. Philip Lum's anthropometric formula is the best way to calculate the needed length. The problem is that we are using the anticipated or expect venous pathway but there could be deviations from the textbooks. You can use a standard anatomy drawing to learn the venous pathway. LynnAt 12:52 AM +0000 3/12/06, [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 VirginiaWhat 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--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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