PICC line management among patients with chronic kidney disease

Abstract

More than 1 million peripherally inserted central catheters (PICC) are placed annually in the US and are used to provide convenient vascular access for a variety of reasons including long term antibiotic treatment, chemotherapy, parenteral nutrition, and blood draws. Although they are relatively easy to place and inexpensive, PICC line use is associated with many complications such as phlebitis/thrombophlebitis, venous thrombosis, catheter-related infection, wound infection, and central vein stenosis. These complications are far more deleterious for patients with chronic kidney disease (CKD) whose lives depend on a functioning hemodialysis access once they reach end stage kidney disease (ESKD). Despite recent guidelines to avoid PICC lines in CKD and ESKD patients, clinical use remains high. There is an ongoing urgency to educate and inform health care providers and the CKD patients themselves in preserving their venous real estate. In this article, we review AV access and PICC line background, complications associated with PICC lines in the CKD population, and recommendations for alternatives to placing a PICC line in this vulnerable patient population.

A decision-making algorithm proposal for PICCs and midlines insertion in patients with advanced kidney disease: A pilot study

“…Algorithms presented in the literature leave up to the assessment of the doctor, in accordance with the guidelines, to decide on the implantation, considering the placement of a vascular catheter in a patient with a life expectancy of less than two years to be acceptable. [17] Moreover, this strategy was also adopted during our enlistment. Nevertheless, assessing mortality is a difficult matter even for experienced physicians and is often affected by subjective bias, so results may change depending on the evaluator.…”

Nurses’ practice of peripherally inserted central catheter maintenance and its influencing factors in Guizhou province, China: a cross-sectional study

“…A peripherally inserted central catheter (PICC) indicates that the catheter is inserted via the peripheral veins (eg, the basilic vein, cephalic vein and median cubital vein) into the lower third of the superior vena cava or subclavian 1–3. PICC has been widely used for long-term transfusion, chemotherapy and parenteral nutrition since it was introduced to China 4–6. It is a reliable form of intravenous access with high patient satisfaction due to some advantages, such as easy operation, long-term use, avoidance of repeated punctures and reduced vascular damage 5 7–9…”

Barriers and facilitators for implementing peripherally inserted central catheter (PICC) appropriateness guidelines: A longitudinal survey study from 34 Michigan hospitals

“…Despite these risks, inappropriate PICC use, defined as placement in situations where risk outweighs benefits, regardless of cost [10], is common [11][12][13]. Examples include patients requiring short-term IV therapy [14,15], patients with prior catheter-related thrombosis [6], and those with kidney dysfunction [16,17]. Alternative, less invasive devices (e.g., peripheral intravenous or midline catheters) may help avoid inappropriate PICC use and complications [10].…”