More than 5 cm is placing the line at risk of being pulled accidentally. I don't even like 5cm. It's just too difficult unless you are going to do all the dressing changes; our team does not.
There are no standards about this, except basic anatomy. The length of the SVC is about 7 cm in most adults. If the original tip location was documented at the cavoatrial junction and they catheter is retracted by more than 2 or 3 cms, I would say there is a signfiicant problem. Of course, you would need to consider the entire situation. How much longer is the PICC required? What is being infused through it? If only a few more doses of ABX it could be acceptable. If infusing TPN or vasopressors, or vesicant chemotherapy, probably needs to be changed. What are the risks to the patient for removal and reinsertion? How many other insertion sites does the patient have? Tip locations higher in the SVC have much higher rates of tip migration into IJ, contralateral subclavian, or other veins. So correct tip location is critical. Of course, I would do an investigation as to why it was dislodged in the first place. If this is a common problem, then you should probably investigate why this is the case - lack of correct stabilization, no stabilization device, failure of the stabilization device being used, inproper dressing change procedures for the stabilization device being used? This can be fixed. lynn
thank you so much for the info. Is there a standard on how many cms can be left external? Of course we want as little as possible, but if the CXR reads I need to pull back 5 cm, am I OK to leave that much out? Is there a "number" considered unacceptable to leave out? (like no more than 3cm...) thanks again!
thank you so much for the info. Is there a standard on how many cms can be left external? Of course we want as little as possible, but if the CXR reads I need to pull back 5 cm, am I OK to leave that much out? Is there a "number" considered unacceptable to leave out? (like no more than 3cm...) thanks again!
There is no such standard. Again, this decision is based on your nursing assessment of the patient and how well you can stabilize the external length. An active 5 or 6 year old or a man whose work involves heavy labor will be a different decision than a 60 year old that is not working, not active, not diaphoretic, etc. The key is what method of stabilization and dressing your are going to use. Lynn
More than 5 cm is placing the line at risk of being pulled accidentally. I don't even like 5cm. It's just too difficult unless you are going to do all the dressing changes; our team does not.
Sheila Hale, MSN, RN, CRNI, VA-BC, Austin, TX
There are no standards about this, except basic anatomy. The length of the SVC is about 7 cm in most adults. If the original tip location was documented at the cavoatrial junction and they catheter is retracted by more than 2 or 3 cms, I would say there is a signfiicant problem. Of course, you would need to consider the entire situation. How much longer is the PICC required? What is being infused through it? If only a few more doses of ABX it could be acceptable. If infusing TPN or vasopressors, or vesicant chemotherapy, probably needs to be changed. What are the risks to the patient for removal and reinsertion? How many other insertion sites does the patient have? Tip locations higher in the SVC have much higher rates of tip migration into IJ, contralateral subclavian, or other veins. So correct tip location is critical. Of course, I would do an investigation as to why it was dislodged in the first place. If this is a common problem, then you should probably investigate why this is the case - lack of correct stabilization, no stabilization device, failure of the stabilization device being used, inproper dressing change procedures for the stabilization device being used? This can be fixed. 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
thank you so much for the info. Is there a standard on how many cms can be left external? Of course we want as little as possible, but if the CXR reads I need to pull back 5 cm, am I OK to leave that much out? Is there a "number" considered unacceptable to leave out? (like no more than 3cm...) thanks again!
Cheryl E. Aldo, RN, BS VA-BC
thank you so much for the info. Is there a standard on how many cms can be left external? Of course we want as little as possible, but if the CXR reads I need to pull back 5 cm, am I OK to leave that much out? Is there a "number" considered unacceptable to leave out? (like no more than 3cm...) thanks again!
Cheryl E. Aldo, RN, BS VA-BC
There is no such standard. Again, this decision is based on your nursing assessment of the patient and how well you can stabilize the external length. An active 5 or 6 year old or a man whose work involves heavy labor will be a different decision than a 60 year old that is not working, not active, not diaphoretic, etc. The key is what method of stabilization and dressing your are going to use. 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