Non-pitting edema and rating

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Specializes in assisted living.

Hi all!

I am a first semester nursing student and in my first clinical. From my understanding "non-pitting" edema was not rated. Is that correct? My instructor has taken points off twice for not rating my "non-pitting" edema. At first I thought she just didn't see the NON part, but when I mentioned it she said that there is 1-4 for non-pitting and 1-4 for pitting. No one I talk to seems to know what she is talking about. I thought the 1-4 stood for how much time it took for the pitting to go away after the skin was pressed on?? I just don't want to keep getting it wrong! Thanks much!!

Marisa

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I have always described edema as either pitting or non-pitting, and used a numeric scale to describe the depth. The facility I presently work at uses the following numeric scale to describe the depth of the depression:

1+: 0 - 0.25 inch

2+: 0.25 - 0.5 inch

3+: 0.5 - 1 inch

4+: >1 inch

You might also review the facility's policies and procedures where you are doing clinicals as they might address this in either a documentation or assessment policy.

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I looked this up one time, don't remember the source, and it connected the rating to pitting edema, not non-pitting. I had been using depth of pitting prior. Can be confusing.

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Hey Marisa, I am no expert, I am a new grad RN. But, what I was taught is that only pitting edema is rated 1-4 based on depth of the indentation made in mm. So, +1 pitting would be 2mm indentation, +2 would be 4 mm indentation, +3 would be 6 mm indentation, and +4 would be 8 mm or more. As far as I know, non-pitting edema is not rated 1-4. Hope you find an answer to this from someone more experienced than I, otherwise, I would definitely discuss this further with your instructor! Best of luck to you.

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Specializes in assisted living.

Hi Chare! So are you saying that non-pitting wouldn't be rated because it wouldn't have any depth? I wasn't sure what you meant. Thanks for your replies everyone!! You would think that something like rating edema would be more straight forward, wouldn't you :-)

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Specializes in ICU/CCU.
Hi Chare! So are you saying that non-pitting wouldn't be rated because it wouldn't have any depth? I wasn't sure what you meant. Thanks for your replies everyone!! You would think that something like rating edema would be more straight forward, wouldn't you :-)

Although I can't speak for Chare, I'm pretty sure that IS what she means. Pitting edema is rated to establish the degree of the edema. 4+ Pitting edema, for instance indicates a far greater fluid overload than 1+ pitting and definitely non-pitting edema.

The 1-4 portion of the scale is ONLY for pitting edema. That would be like being asked to document the number of teeth after you already documented the baby as toothless...

As a matter of fact, documenting a pitting rating when you documented non-pitting would raise a red flag if the file ever went to court. It would display a lack of knowledge, either for the care of the patient as a whole, or at least for the charting system. Both will raise enough doubt in your credibility to become an issue.

I would directly address the issue with your instructor. I'm pretty sure Jarvis even states the exact same rationale for the pitting edema ratings.

With Love,

Dane

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Specializes in Acute Care, Rehab, Palliative.

Ourcharting system has a spot where you check off whether it is pitting or not but also a 1-4 rating for how much edema there is.

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Specializes in Step-down, cardiac.

Your instructor is crazy. As the others stated, pitting edema is rated by how many millimeters of depression the edema holds after you press it. Non-pitting edema could only, by definition, be rated a zero.

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Specializes in assisted living.

Thanks for the replies! That is what I thought! I was so shocked when she said to rate the non-pitting edema. So what would you all do about it? I don't want to keep getting marked off for it, and I don't want to just make something up to make her happy either. I am not sure what I could say to her that wouldn't offend her. She may be the type that isn't that receptive to a student insinuating that she is wrong. Any advice??

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Specializes in assisted living.

Hi Dane,

I just saw your suggestion about the Jarvis. I did look that up and you are correct. I guess I might just ask her about the edema under the pretense that I am not sure how the 1-4 rating system works for the non-pitting and could she explain it so I do it right on this next assignment. Then I will probably bring up the fact that Jarvis says rating is specifically for non-pitting. Hopefully she will be willing to look into it and find that the rating system is just for pitting as well. thanks again for the advice!

Marisa

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Our ICU uses a flowsheet for charting and provides a rating system for non-pitting as well as pitting edema. Next to each rating it provides guidelines to help you determine which rating is most appropriate (pitting is rated by depth/time while non-pitting is rated by area). I'm not familiar with any standard guidelines for rating non-pitting edema but you might check with the unit/facility and see if there is something they use.

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Marisa, I had a question about this just last month, where I work someone was grading NON pitting edema, I was confused! I went to my supervisor , just to see if there was something I was missing, she said No , the grade 1-4 is for PITTING edema, I even looked this up on the internet too, nothing for NON pitting edema.

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