Vein Preservation: An Algorithmic Approach to Vascular Access Placement in Patients With Compromised Renal Function

Abstract

Peripherally inserted central catheters (PICCs) have become ubiquitous in the current management of chronic inpatient and outpatient conditions. Many hospitals have developed practice patterns that allow placement of PICC lines by teams of nurses at the bedside. This practice has led to a proliferation of these central venous access devices, and their use has expanded. One of the consequences of a nurse-based placement team is the decrease in physician involvement in decisions regarding the placement of PICC lines. In some settings, PICC placement can become so routine that the type of access needed or the other clinical conditions affecting an individual patient may be overlooked. One example of this problem is the situation in which a patient with chronic kidney disease or end-stage renal disease needs venous access for a nondialysis reason, such as antibiotics, cancer therapy, or total parenteral nutrition. The author discusses ramifications of this problem as well as ways to reduce the chances of mistakes.