Measuring picc length

MikeyT-c-IV · Jul 28, 2017

Just wondering if this is just something that comes with time and experience once you're comfortable and consistent with your measurement method.

Yes, Absolutely you will get it with time. Different nurses have slightly different methods for measurement. I've been placing lines for almost 10 years and I've figured out good measurements based on insertion site and body size, oh and which arm you are using. A very tall obese patient is obviously going to have a much longer line than a skinny-mini.

I like to have my PICCs exposed exactly 1cm for the biopatch. I pretty much have it down to a fine art but I still get fooled from time-to-time. Just this morning I placed a line in a lady but she was lying in the bed in an odd position for her comfort. My measurement didn't quite come out right and 3cm were exposed.... dangit. But that's the way it goes.

You're measurement technique seems fine. Don't be afraid to play around a little and find a consistent method that works for you. A few centimeters of exposed catheter isn't going to hurt anything, I worry more about having a catheter that is too short.

Now you have me curious, I see you are from OK. I am too, have you heard of OKVAN (Oklahoma Vascular Access Network?) PM me if you want.

UnbrokenRN09, BSN · Jul 29, 2017

No I haven't heard of that particular organization but sounds like something I need to check into! Glad to finally see another fellow okie here lol.

Anyways, my hospital has a really big picc team so I've seen lots of different measurement methods. After studying the X-ray closer, my preceptor pointed out to me that the tip actually could've been 2 cm further, so I guess adding 2 to the measurement made it more accurate because I add 1-2 for vein depth also. I think from now on if I'm not going by 3CG I'll just insert it to zero and then pull back if necessary. Our picc's have a good 2 cm in front of the zero to allow for the biopatch.

iluvivt, BSN, RN · Aug 4, 2017

I have been placing PICCs since 1989 and have seen the progression of the speciality.There is absolutely nothing wrong with leaving some of the PICC length externally visible. In fact our team does it routinely as it gives us more options in how we direct the PICC for dressing changes and ease of care. In addition, if you using a Securacath you must leave at least 3 cm to lock on the device to the PICC. You do not want to leave so much out though that it actually impedes your ability to provide follow-up care. We all like to leave about 4 to 8 cm visible. Remember that it's better to be a tad deep and pull it back than not deep enough. Every complication rate increases the farther away you get from the CAJ. There is no way you will ever get it perfectly correct every time as human beings have too much variation so your real goal should be to get the tip at the CAJ with as little as trauma possible to the selected vein. You should try and check any recent chest films and look at the length of the SVC. The left side can be a tad challenging to measure since the Brachiocephalic is longer as it makes its around the heart so I always measure carefully. I hate being short but worse would be to be short and not having any PICC left to advance because I trimmed it off.

UnbrokenRN09, BSN · Aug 4, 2017

We use statlocks to secure our PICC's, and they hold it in place great, but it's difficult to change the dressing and lock, especially if you have more than 3 cm exposed. That's why I personally don't like having more than 3 out. But yep I'm in total agreement about going deep and pulling back rather than being too short.

My last few measurements have been spot on so I'm feeling better about it. Appreciate the feedback.

iluvivt, BSN, RN · Aug 5, 2017

We just flip up the amt externally visible if 4 or 5 is visible and steri strip it or you could just apply a TSM dressing. Its really easy. I always aim for five visible unless the patient is difficult to measure because of obesity or other has an open chest. or times in the way.

cxbf · Aug 6, 2017

I have been placing and teaching RN's to place PICCs for ten years.

I have two thoughts on trimming PICCs.

First, I have never trimmed a PICC line. PICC lines are manufactured with a smooth rounded ending point for a reason; trimming the lines

produces a jagged end point and may lead to thrombus formation. Also, some lines are reverse tapered and when they are trimmed the widest

part of the catheter is in the smallest part of the vein when it is hubbed or within several centimeters (not sure of the exact number, sorry).

So, for the original poster of this thread - if the catheter you use is reverse tapered, trimming to the exact length may be leading to thrombus formation

in the upper arm. Just a thought to consider.

Second, I know the manufacturers of PICC lines have the capability to produce different length catheters but many choose not to.

Have had many conversations with one company and was told that we just needed to trim out PICCs like everyone else.

Recently changed manufacturers and have had three visits from the previous manufacturer (we place a lot of PICCs in multiple locations).

Why did we change? Several reasons, one being they only make one length. Why didn't we tell them? We did, multiple times. They didn't listen.

Now they are listening. We now have three catheter lengths with the new manufacturer to choose from and we will continue to not trim our PICC lines

for the benefit of our patients.

Just some food for thought. I am sure trimming catheters will continue indefinitely but consider leaving several cm's exposed if the catheter you use is reverse tapered and if you trim, use the best device (I believe that would be the guillotine) to ensure the cleanest cut.

Please read: J Infus Nurs. 2014 Nov-Dec;37(6):466-72. Cutting peripherally inserted central catheters may lead to increased rates of catheter-related deep vein thrombosis.

UnbrokenRN09, BSN · Aug 23, 2017

That's a very interesting point cxbf and I will bring that up to our head picc nurse. Our catheters are reverse tapered and only come in 1 length. Our facility only allows for 6 cm to be exposed. Our piccs are 55cm so, on average you would have 8-15cm exposed if you put the whole thing in. That just seems to me like a disaster waiting to happen as far as infection risk and accidental malpositions with dressing changes. Having piccs in different lengths makes perfect sense to me if it's a tapered catheter. I have recently heard that bard is trialing a 4fr double lumen picc. That would definitely be more ideal for a lot of the patient population I deal with.

Personally, I think the groshong piccs make the most sense because they're trimmed from the outside after the picc is inserted to the correct depth, but I've been told this type is more difficult to place because it is very flimsy and they have a tendency to clot off easier. I suppose each type of line has its pros and cons.

But regardless....being as accurate as possible with your measurement leads to less overall trauma and complications for the patient which is what I'm going for here.

IVRUS, BSN, RN · Aug 28, 2017

"Personally, I think the groshong piccs make the most sense because they're trimmed from the outside after the picc is inserted to the correct depth, but I've been told this type is more difficult to place because it is very flimsy and they have a tendency to clot off easier. I suppose each type of line has its pros and cons."

I totally disagree.... I believe that Groshong IV catheters are the easiest to place, and in my experience, they DO NOT clot off like open ended PICC's do. Plus, you avoid HIT and they're repairable.

iluvivt, BSN, RN · Aug 29, 2017

Groshong PICCs are not any more difficult to place than other PICC and there is no evidence that they have more thrombotoc occlusions. The problem with the silicone PICC is non-IV specialist are allowed to instill Cath-flo they often create holes in the catheter by not instilling the Tpa properly. That is why ultimately we had to switch.

IVRUS, BSN, RN · Aug 29, 2017

Groshong PICCs are not any more difficult to place than other PICC and there is no evidence that they have more thrombotoc occlusions. The problem with the silicone PICC is non-IV specialist are allowed to instill Cath-flo they often create holes in the catheter by not instilling the Tpa properly. That is why ultimately we had to switch.

Agreed. And that is why, I believe, only the Vascular Access RN should be declotting lines.

iluvivt, BSN, RN · Aug 30, 2017

The bottom line with trimming or not trimming PICCs is that there are pros and cons and the decision should be patient specific. The benefit verses the risk should be weighed. If you do not trim and leave a large amount externally visible you risk problems with maintenance and dressing changes. It can be very difficult to maintain and often difficult to catch a change in the amount externally visible. If this is significant and not caught every complication is increased the farther away you get from the cavoatrial junction. Many PICCs are placed that are not cared for by an IV specialist and you want to make the maintenance as easy as possible. If you decide that the patient has an increased risk for thrombosis then you may want to select an antithrombotic PICC,not trim, or trim with a quiloteen, try to perform an atraumatic insertion and monitor more frequently.