Background, Rationale and Suggested Implementation Strategies
- 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
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