Hello!
The vascular access team in my facility is having a debate. This is in regards to what to document for total length of a trimmable PICC line. I have always been with the school of thought that you should count all "insertable length" as part of total length. An example would be trimming a line and cutting it on the 45cm mark. My thought is that the total length of this catheter is actually 46cm since there is that extra 1cm past the 0 mark on the other end. I feel that this extra 1cm is insertable (tehcnically) and should be accounted for. This brings us to another question and further debate. I do not support hubbing the catheter and having no external length because I feel this could lead to possible increased thrombus risk related to the reverse taper. If we assume that the above mentioned line that was trimmed at the 45cm mark is actually 46cm.....those that document it as 45cm total length and then hub it would be inserting an extra cm of length that they are not accounting for.
Can you offer me any advice? #1) What do you all document for total length and why? #2) Should we always try not to hub the catheters at the insertion site? We thought that asking for the assistance of a team of experts would be a great way to get some feedback! Thank you for your input. It will be much appreciated.
Sincerely, Jenny Kettle, RN, BSN, CRNI, VA-BC
When you remove a PICC from the package, there are 2 lengths to know - the effective catheter length and the total catheter length. The effective catheter length is the part designed to be inserted into the vein. The total catheter length is just that, including extension legs and hubs. What you have called the insertable length is the same as the effective length. All PICCs are not marked in the same manner. I would document the length trimmed off of the effective length, the length actually residing under the skin, and the amount of effective length left external. I would not include the total length. On each dressing change I would measure the external effective length and document that each time. This will tell you if the catheter has moved inward or outward, as it can do both.
Also, all PICCs do not have a tapered portion left at the insertion site. All tapers have varying lengths and diameters. If you are using a catheter with a long taper, you are placing the largest catheter diameter into the smallest vein diamater, which could increase your risk of thrombosis at the or near the insertion site. So advancing the entire taper into the vein would depend upon many factors - size of the taper vs diameter of the vein, depth of the vein and the length of the taper that will actually reach the intraluminal space.
Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861