Nephrologists Versus Peripherally Inserted Central Catheters: Are the PICCs Winning?

Kalloo, Sean; Wish, Jay B.

doi:10.2215/cjn.05750516

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…Given the need to preserve veins for AV fistula creation in patients with ESKD, utilization of peripherally inserted central catheters or mid‐axillary intravenous access (midlines) should be avoided at all costs. Recent work has highlighted the inappropriate utilization of venous access and peripheral arm veins in patients with ESKD in a national US database, as well as patients with CKD stage 3b and greater in a large hospital network, demonstrating that there is work to be done in ensuring that vascular access is preserved in patients with CKD requiring long‐term intravenous antibiotics 46‐48 …”

Section: Infections and Antibiotic Therapymentioning

confidence: 99%

How ESKD complicates the management of diabetic foot ulcers: The vital role of the dialysis team in prevention, early detection, and support of multidisciplinary treatment to reduce lower extremity amputations

Allison

Flanagin

2020

Seminars in Dialysis

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Diabetic foot ulcers do not heal as well in ESKD as in the absence of kidney failure, and rates of lower extremity amputation (LEA) are higher. Foot ulcer is the root cause of the majority of LEA in diabetes mellitus, but with early detection, many amputations can be prevented by a comprehensive and multidisciplinary approach. Wound healing encompasses nutrition, smoking cessation, glycemic control, appropriate offloading, compliance with wound care visits and dressing changes, vascular work-up, and intervention as indicated, and antibiotics if needed. While many of these items are outside the scope of the dialysis visit, foot checks, foot care education, nutrition, and smoking cessation should be addressed as part of routine dialysis patient care. In addition, nephrologists who understand wound care principles can give additional support to their patients during the intensive phase of wound care treatments, which often comprises weekly sharp debridement. The evidence shows that integrating care into the dialysis treatment setting improves foot-related outcomes; dialysis team education and vigilance are essential, and nephrologists are uniquely positioned to lead this effort. We know enough to act to improve the outcomes of ESKD patients with foot ulcers. AbstractDiabetic foot ulcers do not heal as well in ESKD as in the absence of kidney failure, and rates of recurrent foot ulcers, as well as lower extremity amputation, are higher. This review of the literature highlights the vital role of the dialysis team in prevention, early detection, and support of treatment of diabetic foot ulcers. Our review has five goals-(a) increase nephrologists' understanding of the high morbidity and mortality associated with chronic foot ulcers and (lower extrimity) LE amputations in ESKD; (b) promote nephrologists' understanding of grading systems for diabetic foot ulcer severity, in order to expedite communication with local diabetic foot experts; (c) promote collaboration between nephrologists and infectious disease specialists regarding the dose, route, and delivery logistics of intravenous antibiotics for infected chronic foot ulcers, in particular in the presence of osteomyelitis and other deep-seated infections; (d) increase the awareness of dialysis nurses, technicians, dietitians, social workers and administrators regarding evidence-based and multidisciplinary approaches to patients' diabetic foot ulcers; (e) encourage the application of published works integrating patient-centered diabetic foot education into the dialysis setting to reduce lower extremity amputations.

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Section: Infections and Antibiotic Therapymentioning

confidence: 99%

How ESKD complicates the management of diabetic foot ulcers: The vital role of the dialysis team in prevention, early detection, and support of multidisciplinary treatment to reduce lower extremity amputations

Allison

Flanagin

2020

Seminars in Dialysis

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“…In particular, the forearm and upper arm veins should not be used for venipuncture or the placement of intravenous catheters, subclavian catheters, or PICC lines. 2,3 Multiple other societies and workgroups have published guidelines and recommendations for PICC line avoidance in CKD patients. 2 Despite these guidelines, PICC line use remains high.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Multiple other societies and workgroups have published guidelines and recommendations for PICC line avoidance in CKD patients. 2 Despite these guidelines, PICC line use remains high. In a recent study conducted in seven Mayo Clinic outpatient hemodialysis units, 30% of patients were found to have a history of PICC line use.…”

Section: Introductionmentioning

confidence: 99%

PICC line management among patients with chronic kidney disease

Oza-Gajera

Davis²,

Farrington

et al. 2021

J Vasc Access

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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.

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“…9 This is of particular interest in patients with chronic kidney disease (CKD) as it may compromise future vascular access using tunneled venous catheters or dialysis fistula. 1,10–13…”

Section: Introductionmentioning

confidence: 99%

“…9 This is of particular interest in patients with chronic kidney disease (CKD) as it may compromise future vascular access using tunneled venous catheters or dialysis fistula. 1,[10][11][12][13] The 2019 update of the Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guidelines recommends the preservation of central and peripheral upper extremity veins from vascular damage by avoiding the placement of central catheters and PICCs or venipunctures in patients on dialysis or grade 3-5 CKD. 12 PICC insertion in these patients requires a nephrology consultation, and should be avoided if required for <7 days.…”

Section: Introductionmentioning

confidence: 99%

Peripheral central catheter insertion in low eGFR patients: Retrospective single institution study

et al. 2021

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Purpose: To identify the rate of Peripherally Inserted Central Catheter (PICC) placement in patients with chronic kidney disease (CKD), stage 3B or higher (glomerular filtration rate (eGFR) <45 mL/min/1.73 m2). Material and methods: A retrospective study of 2825 adult patients (male 51.2%, female 48.8%) who had a PICC insertion from January 2017 to December 2019. The data collected includes gender, eGFR value at the date of insertion, accessed vein and side, ongoing or subsequent dialysis within 1 year, and death within 1 year of the insertion date. The study excluded pediatric patients, patients with missing eGFR values prior to the procedure and follow-up information. Result: PICC insertion was done in patients with eGFR⩽45 mL/min/1.73 m2 in 26.7% (724/2709) of the sample. Ongoing dialysis was documented in 10.2% (198/1946) and subsequent dialysis in 6.5% of the patients within the year after insertion. The overall death rate for the year post PICC insertion was 38.7% (1094/2825), which was significantly higher in low eGFR patients (413/724, 57%) compared to patients with eGFR>45 mL/min/1.73 m2 (632/1985, 31.8%) ( p-value < 0.0001, odds ratio 2.84 (95% confidence interval 2.38–3.38)). The rate of dialysis initiated in the year post PICC insertion was 5.9% (98/1657). This was significantly higher in patients with a low eGFR and not previously dialyzed (59/310, 19%) compared to patients with eGFR>45 who required dialysis in the year post insertion (39/1347, 2.9%) ( p < 0.0001, odds ratio 7.88 (95% confidence interval 5.14–12.07)). Conclusion: PICC insertion in patients with CKD is practiced frequently. Rigorous strategies should be implemented to improve adherence to clinical practice guidelines and reduce unnecessary insertions and preserve veins for when an AVF may be required.

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Nephrologists Versus Peripherally Inserted Central Catheters: Are the PICCs Winning?

Cited by 4 publications

References 10 publications

How ESKD complicates the management of diabetic foot ulcers: The vital role of the dialysis team in prevention, early detection, and support of multidisciplinary treatment to reduce lower extremity amputations

How ESKD complicates the management of diabetic foot ulcers: The vital role of the dialysis team in prevention, early detection, and support of multidisciplinary treatment to reduce lower extremity amputations

PICC line management among patients with chronic kidney disease

Peripheral central catheter insertion in low eGFR patients: Retrospective single institution study

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