Use of PICCs in patients with advanced chronic kidney disease

In this sample of hospitalized patients who received PICCs, placement in those with CKD was common and not concordant with clinical guidelines” Paje et al 92019).

Abstract:

BACKGROUND: Existing guidelines, including Choosing Wisely recommendations, endorse avoiding placement of peripherally inserted central catheters (PICCs) in patients with chronic kidney disease (CKD).

OBJECTIVE: To describe the frequency of and characteristics associated with PICC use in hospitalized patients with stage 3b or greater CKD (glomerular filtration rate <45 mL/min/1.73 m2). DESIGN: Prospective cohort study. SETTING: 52 hospitals participating in the Michigan Hospital Medicine Safety Consortium. PARTICIPANTS: Hospitalized medical patients who received a PICC between November 2013 and September 2016. MEASUREMENTS: Percentage of patients receiving PICCs who had CKD, frequency of PICC-related complications, and variation in the proportion of PICCs placed in patients with CKD. RESULTS: Of 20 545 patients who had PICCs placed, 4743 (23.1% [95% CI, 20.9% to 25.3%]) had an estimated GFR (eGFR) less than 45 mL/min/1.73 m2 and 699 (3.4%) were receiving hemodialysis. In the intensive care unit (ICU), 30.9% (CI, 29.7% to 32.2%) of patients receiving PICCs had an eGFR less than 45 mL/min/1.73 m2; the corresponding percentage in wards was 19.3% (CI, 18.8% to 19.9%). Among patients with an eGFR less than 45 mL/min/1.73 m2, multilumen PICCs were placed more frequently than single-lumen PICCs. In wards, PICC-related complications occurred in 15.3% of patients with an eGFR less than 45 mL/min/1.73 m2 and in 15.2% of those with an eGFR of 45 mL/min/1.73 m2 or higher. The corresponding percentages in ICU settings were 22.4% and 23.9%. In patients with an eGFR less than 45 mL/min/1.73 m2, PICC placement varied widely across hospitals (interquartile range, 23.7% to 37.8% in ICUs and 12.8% to 23.7% in wards). LIMITATION: Nephrologist approval for placement could not be determined, and 2.7% of eGFR values were unknown and excluded. CONCLUSION: In this sample of hospitalized patients who received PICCs, placement in those with CKD was common and not concordant with clinical guidelines. PRIMARY FUNDING SOURCE: Blue Cross Blue Shield of Michigan and Blue Care Network.

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Reference:

Paje, D., Rogers, M.A.M., Conlon, A., Flanders, S.A., Bernstein, S.J. and Chopra, V. (2019) Use of Peripherally Inserted Central Catheters in Patients With Advanced Chronic Kidney Disease: A Prospective Cohort Study. Annals of Internal Medicine. June 4th. doi: 10.7326/M18-2937. .

Safety IV catheter