Overuse of PICCs in CKD patients
PICCs (or PICC lines to those suffering from the redundant acronym syndrome) have become popular because they offer a convenient option for IV access and blood sampling. They are becoming the default option for patients who are a “tough stick” or have special IV therapy needs. These are usually the sicker patients who are likely to have CKD. But there's a problem in CKD patients. PICC use may jeopardize future dialysis access and current guidelines discourage the practice.
But a recent study presented at the National Kidney Foundation meeting (via Medpage Today) showed that the practice is common in advanced CKD patients. According to one of the discussants:
She explained that at her institution, they have started a program to reduce PICC placement in CKD patients. "For anyone with a glomerular filtration rate of less than 30 mg/L, you cannot just order a PICC. You have to go through an algorithm where you consider other line placements."
3 comments:
Very interesting and something I had never considered. As an anesthesiologist, I'm often grateful for PICCs because these patients usually have difficult IV access, and the PICC allows me to induce anesthesia and then secure a higher flow IV once the veins dilate. I wish the authors had commented on what other options should be considered, because I think often in these patients, there simply aren't a lot of options, and that is why they get PICCs.
I spoke about this during ASN Kidney Week 2007 in SF. Here's a couple of resources:
http://www.therenalnetwork.org/qi/resources/HospitalSystemChangeConcept_Tools/GuidelinesForPICCAvoidanceInChronicKidneyDisease-TipSheet.pdf
http://www.uphs.upenn.edu/renal/important%20pdf%20III/Saad-Vesely%20venous%20access.pdf
I believe that the current recommendation is that if long-term IV access is deemed absolutely necessary in these patients, one may consider a small bore IJ tunneled catheter as opposed to a PICC.
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