Avoid PICC Placement in Patients with eGFR < 45 ml/min (CKD Stage IIIb)
Use of PICCs in patients with advanced kidney disease (per the National Kidney Foundation, those with an estimated GFR (eGFR)
< 45 ml/min) is contraindicated as these patients are likely to progress to hemodialysis. PICC placement in such patients is the strongest risk factor for subsequent fistula failure and is contraindicated if renal replacement therapy is likely.
When PICC placement in patients with eGFR < 45 is requested, empower PICC inserters to ask for approval from nephrology and explore alternative devices prior to placing the PICC
Patients with eGFR < 45 are candidates for small bore central catheters (SBCCs) rather than PICC if long-term venous access is necessary. SBCCs do not lead to stenosis of arm veins
Develop strategies to place SBCCs in consultation with interventional radiology or other operators that oversee PICC placement
Consider changes to the electronic health system that flag patients with reduced eGFR to indicate a contra-indication to PICC use
Resources & Tools:
HMS site reports (hard copy distributed at collaborative wide meetings and live reports available daily via the HMS data entry system)
The decision to place PICCs in patients with Chronic Kidney Disease requires physician oversight and involvement. An algorithm is presented for access assessment with particular attention to patients with CKD Stages 4 and 5. Development and implementation of such an algorithm is recommended.
This commentary highlights the important role nephrologists should play in making decisions regarding PICC use in patients with CKD. The comment emphasizes protocols, use of electronic tools and patient engagement to avoid PICC use when their kidney function declines.
In hospitalized patients who received PICCs, placement in those with CKD was common and not concordant with clinical guidelines. 1 in 4 patients who get a PICC have CKD. Note: Publication is based on data provided by the Michigan Hospital Medicine Safety (HMS) Consortium