External Catheter Length for CVCs and How Much Is Too Much?
External catheter length, or that amount of catheter that extends beyond the insertion site, is based on establishing correct terminal tip. Once the end of the catheter is positioned in the distal Superior Vena Cava the amount of catheter extending beyond the insertion point is set. The real question is "How does the amount outside the insertion site contribute to complications?". No research has effectively addressed this issue making it a great topic for study. Many educators, myself included, have stated that more catheter out means a greater chance of accidental dislodgement. "The more out, the more that will be out later." There is no definitive information confirming this conclusion, simply The flip side of this is: how much of the catheter should be pushed into the insertion site/how much should be left out to be optimal? This question has not been answered by any literature I have read. It is necessary to leave a space of approximately 1cm to enable certain antimicrobial sponges to completely encircle the catheter. I think we can all agree the ideal is to have .5-2cm of the catheter remaining external. In order to achieve this for all CVCs and especially PICCs we will need to have technology that allows a measurement similar to fluoroscopic guidance with wire insertion to the designated target area, catheter trim or adjustment for insertion of the exact amount of catheter needed. I am interested to see how improvements in devices and options affect this issue over the next few years.
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