It is essential to understand that vein protection must begin long before initiation of HD is needed. It cannot be over emphasized that the potential long-term consequences of the PICCs must be weighed against their short-term convenience in CKD patients. The ultimate responsibility lies with nephrology community to educate non-nephrologist clinicians about the need to have vein protection strategies aimed at preserving future HD access. Moreover, given the fact that PICC insertion occurs most commonly in the hospital setting, there is a pressing need to apprise the practitioners/clinicians of careful selection of patients. Furthermore, there is a need for the interventionists who place the lines to be aware of and to adhere to afore mentioned guidelines. At institutional level, policies and protocols that require nephrology consultation for any PICC request in patients with CKD may be considered and implemented. This may require a collaborative approach among physicians from various specialties and could be facilitated with electronic alerts in hospitals where electronic health records are in use. Last but not the least, awareness needs to be created among patients suffering from CKD and their family members about the potential risks and avoidance of PICCs.
Reference:Yaqub, S. and Abdul Razzaque, M.R. (2020) Peripherally inserted central catheters (PICC) use in patients with chronic kidney disease (CKD). JPMA. The Journal of the Pakistan Medical Association. 70(4), p.771. doi: 10.5455/JPMA.55207.