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Kidney Week

Abstract: TH-PO1141

Factors Influencing Approval Rates of Peripherally Inserted Central Catheters (PICCs) in Patients with Kidney Disease

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Chernova, Irene, Yale New Haven Hospital, New Haven, Connecticut, United States
  • Cavanaugh, Corey J., Yale New Haven Hospital, New Haven, Connecticut, United States
  • Kodali, Ravi, Yale New Haven Hospital, New Haven, Connecticut, United States
  • Okoba, Ngozi, Yale New Haven Hospital, New Haven, Connecticut, United States
  • Virmani, Sarthak, Yale New Haven Hospital, New Haven, Connecticut, United States
  • Belcher, Justin Miles, Yale University, New Haven, Connecticut, United States

Group or Team Name

  • Yale Nephrology Fellows
Background

Current guidelines recommend against placement of peripherally inserted central catheters (PICCs) in stage 3-5 CKD without nephrology consultation in an attempt to preserve veins for future arteriovenous fistula access creation for hemodialysis. In many instances, nephrology input is also required for PICC placement for patients with acute kidney injury (AKI). With no official guidelines delimiting patients appropriate for PICCs, the consult burden on renal fellows can be significant. Here we attempted to determine medical and demographic factors influencing our practice patterns for approving PICC placement to develop objective guidelines identifying patients who unanimously are or are not appropriate for PICCs to potentially reduce the burden of consults.

Methods

We identified over 100 patients in whom a PICC consult was placed to nephrology over 10 months at 3 separate hospitals. We evaluated the PICC approval rate accounting for age, gender, serum creatinine at time of consult and baseline, CKD stage, AKI stage, diabetes, hypertension and end-stage comorbidities (cirrhosis, heart failure, malignancy, dementia, hospice). PICC placement decision for the initial 51 patients was adjudicated by the first year class of clinical fellows and 1 attending nephrologist in a blinded manner.

Results

Of the 51 adjudicated patients, 24/51 (47%) had universal agreement between both the original consulting fellow and the adjudicating fellows and attending. Presence of end-stage diagnosis, hospice status and advanced age were the major factors predictive of universal agreement for PICC placement while stage 4-5 CKD in younger patients correlated highly with nephrology recommending against PICC placement.

Conclusion

These preliminary data suggest that certain patient characteristics (such as an end-stage diagnosis) correlate highly with PICC approval including in patients with CKD stage 3-5 who may otherwise be excluded from PICC placement based on strict guidelines. Further analysis is currently underway to facilitate the development of an objective criteria list which can be used to standardize decision-making regarding PICC placement amongst nephrology practitioners and provide guidance to practitioners as to when a nephrology consult is indicated.

Funding

  • Clinical Revenue Support