“A 45-year-old man is admitted to the hospital for sepsis secondary to osteomyelitis. He has diabetes mellitus, hypertension, and stage 3 chronic kidney disease (CKD), with a glomerular filtration rate of 46 mL/min/1.73m2. He is treated with intravenous (IV) antibiotics and improves clinically. He will need 6 weeks of IV antibiotics after discharge. Should a peripherally inserted central catheter (PICC) be placed for IV access?

The decision to place a PICC must be individualized for the patient. Current guidelines do not provide explicit contraindications for creating permanent vascular access, but the general consensus is that poor candidates include those with advanced dementia, left ventricular ejection fraction less than 20%, poor vasculature on imaging, or terminal illness (life expectancy < 6–12 months).1 In addition, national guidelines and the American Board of Internal Medicine’s Choosing Wisely initiative recommend against PICC placement in patients expected to need permanent dialysis access in the future (CKD stages 3–5)."

Garcilazo NHH, Hassanein M, Vachharajani TJ, Anvari E. Can I place a peripherally inserted central catheter in my patient with chronic kidney disease? Cleve Clin J Med. 2021 Aug 2;88(8):431-433. doi: 10.3949/ccjm.88a.20173. PMID: 34341026.