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Discussion

PICC or Central Line?

I work on a med/oncology floor and we have many dialysis patients. I was wondering, in your practice, how often do you see PICCs? I have read on medscape, and have heard at work from one of the PICC nurses that PICCs are not a good choice for the dialysis pt, due to obvious issues of scarring.

I am hoping someone can furnish me with some evidence-based articles, nursing and/or medical, to support the NO PICC issue. Thanks in advance.

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We see PICC lines frequently for home chemo and/or some antibiotics. Some of my patients also have Medi-ports. PICC line is okay for dialysis pts. Just have to be very careful of sepsis as with any line in dialysis pts.

"Peripherally inserted central catheters — The use of peripherally inserted central catheters (PICC) lines is associated with a high incidence of venous stenosis. This is especially true for peripheral veins [19] , but is also the case for central veins. This was shown in a study that reviewed venographic studies performed both before and after insertion of PICCs in 150 patients to determine the incidence of central venous stenosis or occlusion [8] . It was found that 7.5 percent of patients with previously normal central venograms developed subsequent venographic abnormalities after PICC placement; 4.8 percent developed central venous stenosis and 2.7 percent had central venous occlusion."

http://www.uptodate.com/online/content/topic.do?topicKey=dialysis/32202&selectedTitle=1~150&source=search_result#8

I do apologize as you may not be able to access the URL because it is from Up To Date to which you must be a subscriber. However, this is the source that we (nephrology practice) utilize. Hope this helps a little.

first time i hear PICCs are used for HD. Wow! how can they do it? VasCath can barely provide an adequate blood flow. I can't imagine that.

Of central catheters we use only VasCath and PermaCath.

BTW are you russian?

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first time i hear PICCs are used for HD. Wow! how can they do it? VasCath can barely provide an adequate blood flow. I can't imagine that.

Of central catheters we use only VasCath and PermaCath.

BTW are you russian?

...no, not used FOR HD, there has to be a fistula or permacath for that. But IV access is a tricky thing for the dialysis patient, we don't want to use up or mess up what veins they have left.

PICCs are great if you need IV access for an extended length of time. =)

My place uses them a lot and supposidly has an almost 0% infection rate.

Interesting post... thanks for the link TraumaR... only seen port-a-cath's on HD pt's:smokin:

I work on a med/oncology floor and we have many dialysis patients. I was wondering, in your practice, how often do you see PICCs? I have read on medscape, and have heard at work from one of the PICC nurses that PICCs are not a good choice for the dialysis pt, due to obvious issues of scarring.

I am hoping someone can furnish me with some evidence-based articles, nursing and/or medical, to support the NO PICC issue. Thanks in advance.

http://www.ncbi.nlm.nih.gov/pubmed/11099241

I work on a med-renal unit. We do not place PICC's in CRF patients d/t the risk of scarring the veins and causing them to lose the option to place a fistula at a later date. Infection is a concern in any patient population, but a permcath would be just a risky so this is obviously not the reason for not using PICCs. I would encourage you to consult your patient's nephrologist before allowing a PICC to be placed. Many MD's from other specialties do not understand this and will often order a PICC inappropriately. Our IV therapy team has been well trained by many such mishaps and will not place a PICC or a midline without an order from the nephrologist.

I think that the PICCs aren't appropiate for dialysis, basically because the higher resistance to the boodflow (in dialysis we need an venous access with high volume (and the lowest resistance) for being efficient). The PICCs are best for long term treatments with highly irritative meds like chemo or antibiotics.

(I'm from Chile)

Best Regards,

Magdalena

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