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Abstract: TH-PO283

Analysis of Use and Outcomes of Peripherally Inserted Central Venous Catheters in Advanced CKD and ESKD

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Barrios, Richard, University of Miami Health System, Miami, Florida, United States
  • Sosa, Marie A., University of Miami Health System, Miami, Florida, United States
  • Chavez, Efren, University of Miami Health System, Miami, Florida, United States
Background

Peripherally inserted central venous catheter (PICC) placement is an independent risk factor for AVF failure suspected due to venous injury resulting from thrombosis, intimal hyperplasia, and stenosis. The overall probability of achieving any permanent vascular access is lower for patients exposed to PICCs.

Methods

This is a cross-sectional, retrospective study aimed to investigate incidence of PICC placement in adult patients with advanced CKD (defined as eGFR <30 ml/min/1.73m2) and ESKD based on ICD-10 diagnoses admitted to UHealth Tower (UHT) from 10/2020 to 2/2022. Hospice patients were excluded.

Results

From a total of 1,074 patients with advanced CKD/ESKD admitted to UHT over 15 months 87 out of 1,074 patients (8.1%) had a PICC placed. Of these 87 patients, 49%, 6.0%, and 45% carried a diagnosis of CKD-4, CKD-5, and ESKD, respectively. Most of the patients who experienced PICC placement were men (n=48) with a median age of 69 years, white (n=51) and Hispanic/Latino (n=50). A total of 9 out of 87 (9.1%) of PICCs placed within this population were complicated by DVT formation. The veins cannulated during PICC insertion were predominantly basilic vein (73.5%) and brachial vein (20.6%). The majority of the PICCs placed were dual lumen catheters (n=62). Indications for PICC placement were the following: ICU care (59.75%), prolonged antibiotic therapy (23%), chemotherapy (10.3%), TPN (4.6%) and other IV medications or frequent blood draws (3.45%).

Conclusion

There is a high prevalence of PICC insertion in advanced CKD/ESKD patients at UHT. We observed an incidence of PICC-related DVTs of 9.1% in our analysis, which is higher compared to a 2.4% PICC-related DVT incidence described in the literature. Nearly 60% of PICCs were placed in the ICU. 81% of PICCs were ≥2 lumens with a diameter ≥5 Fr. Catheters with a larger diameter and higher number of lumens are associated with a higher thrombotic risk. Nevertheless, in patients with CKD stage 3B or greater, PICC placement is generally contraindicated, and recommendations should be individualized considering the likelihood of requiring KRT, urgency of the situation, and availability of resources. In advanced CKD/ESKD patients who have an absolute need for prolonged central venous access the implementation of alternative interventions should be encouraged.

Funding

  • Private Foundation Support