Measuring Veins for PICC Placement

Specialties Infusion

Published

Hello,

Our VAT measures vein diameter for PICC placement and we have been doing so for some time. However, we have never been formally taught how to do it. So my question is how does everyone else measure? Do you measure side to side vs up and down vs diagonally? Thanks so much! I’ve looked everywhere for formal literature on how to measure and can’t find it anywhere.

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Specializes in ER, ICU, Infusion, peds, informatics.

Well, they are generally round ... if you are getting a more oblong shape you probably have too much pressure with the probe.

If I'm getting some compression distortion, I measure the shortest distance. If that is "too small" for the device I want to use and I think compression is playing a role, I try to lighten the pressure as long as I can maintain the image. Otherwise, if the shorter distance gives me <33% vein capacity, I don't worry about it since we're just documenting appropriate vein selection and not gathering data for research.

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Thanks for your reply. We are from the pediatric world so this practice of measuring has caused a lot of tension with the physicians and our team since we are telling them that we are unable to place a picc line due to the patient not having a vessel large enough. Before we started measuring we would simply eyeball it and figure it would fit.

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Specializes in Critical Care.

Some ultrasounds can give you an estimate or help you determine if a 4-Fr or 5-Fr. catheter would cause DVT or some sort by calculating catheter size to vein diameter. Majority of ultrasounds show you different catheter size by French on your screen when scanning for vein. If you want to, let's say, fit a 4-Fr. in any of the great vessels, use those catheter size provided on your ultrasound screen and try fitting 3 of them in that vein you want to access. That's a good way to determine vein size for your catheter size. Hope that helps.

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Specializes in Vascular Access.

We measure and go by the 45% of the diameter rule from INS for PICCs, that is, if our catheter takes up 45% or less of the vein then we proceed with placement. Our Bard Site-Rite ultrasounds measure the catheter to vein ratio for us, our Sonosites measure distance. Our facility has a table of measurements that we go by for PIVs that tells us what diameter of vein we need to see (without a tourniquet) for what gauge PIV we can place.

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Specializes in Critical Care.

CN21IVT, thank you for making it clear. That’s what I was trying to say on my previous post. You are 100% correct there. Question, at my full-time, I use BARD PICCs and at my other job, I use ArroW for PICC and PowerWand XL for Midlines. Any intake? I find BARD is more easy to use whereas, ArroW is not and PowerWand is not patient friendly... lots of complications.

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