Many CKD Patients Receive PICCs Despite Contraindications

A new study reveals that close to a third of hospitalized patients who receive a peripherally inserted central catheter (PICC) suffer from advanced chronic kidney disease (CKD), despite contraindications.

Researchers at the VA Ann Arbor Healthcare System (MI, USA), the University of Michigan (U-M) Medical School (Ann Arbor, USA), and other institutions analyzed inpatient data from 52 hospitals in order to study PICC use in patients with CKD, despite contraindications that suggest they should be avoided so as to preserve future vascular access. The primary outcome was percentage of PICC patients with an estimated glomerular filtration rate (GFR) indicating stage 3b or higher CKD.

The results revealed that of the 20,545 patients who had a PICC placed during their hospital stay, an average of 23.1% had CKD (32.1% in the ICU and 18.9% on the wards). Older patients were more likely to receive a PICC than younger patients, and 3.4% of patients on hemodialysis also had a PICC placed during their hospital stay. Multilumen PICCs were placed more frequently than single-lumen PICCs both in patients in the ICU and on the wards. Two thirds of the CKD patients had their PICC removed prior to hospital discharge. The study was published on June 4, 2019, in Annals of Internal Medicine.

“Vascular access is critical for patients with CKD, who may require renal replacement therapy. Yet despite guidelines that recommend against the use of PICCs in patients with CKD, we found that such practice is common and discordant with guidelines,” said lead author David Paje, MD, MPH, of U-M Medical School, and colleagues. “The most common complication associated with PICC use in patients with CKD was catheter occlusion. However, major complications, including venous thromboembolism and infection, were not uncommon.”

CKD is a progressive loss in kidney function that takes place over a period of months or even years. The symptoms of worsening kidney function are not specific, and might include feeling generally unwell and experiencing a reduced appetite. It is identified by a presence of creatinine, a breakdown product of muscle metabolism. Higher levels of creatinine indicate a lower GFR, resulting in a decreased capability of the kidneys to excrete waste products.

Related Links:
VA Ann Arbor Healthcare System
University of Michigan Medical School