AV fistulas do not last forever. Most long term dialysis patients have more than one in their lifetime, and many of my patients have had multiple shunts done. Even if a patient already has an AV fistula, or has a pre-selected site for one to be made, we do not insert PICCs in these patients. We also discourage subclavian catheter insertion. We recommend right IJ line insertions for these patients, as this is the shortest and straightest route to SVC, thereby causing the least amount of potential vein damage. A short term RIJ CVC is recommended for short duration of therapy, and a tunneled RIJ catheter is recommended for longer term IV access need. The only time we put PICCs in CRF or ESRD patients is when they are imminently terminal. We get support from the nephrologists for all this.
Check the DOQI Guidelines - venous preservation is essential for these patients.
Leigh Ann
-----Original Message-----
From: Dianne Sim <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Sent: Thu, 1 Jun 2006 16:16:28 -0700
Subject: RE: Renal Criteria for PICC line insertion
Our consultants are instructed to ascertain if the patient has a renal diagnosis. If they do they are to phone the nephrologist to inquire if there is an expectation of inserting an A-V shunt in the future, and in which arm they are wishing to do so. On rare occasion we find a nephrologist who doesn’t want a PICC placed in either arm because they have full expectation of placing the A-V shunt, but haven’t assessed the patient’s vasculature as yet.
Dianne Sim RN
CEO & President
CEO & President
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IV Assist, Inc.,
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From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] ] On Behalf Of [EMAIL PROTECTED]
Sent: Thursday, June 01, 2006 11:58 AM
To: [EMAIL PROTECTED]
Cc:[EMAIL PROTECTED] ; [EMAIL PROTECTED]
Subject: Re: Renal Criteria for PICC line insertion
Sent: Thursday, June 01, 2006 11:58 AM
To: [EMAIL PROTECTED]
Cc:
Subject: Re: Renal Criteria for PICC line insertion
I can not using certain meds based on creat level, but not placement itself. Did he give the basis for this? My Home Infusion Pharmacy is really, really conservative and they say they know of no reason for non-placement due to creatinine.
Michael E. Johnson, RN, BSN
Outpatient Infusion Case Manager
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KaiserSanta Clara –Homestead
710Lawrence
Infusion Center
Santa Clara , California 95051
408-851-4301, tie line 401
Pager 6-476, 408-231-0988
fax 408-851-4359, tie line 401
Outpatient Infusion Case Manager
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Kaiser
710
408-851-4301, tie line 401
Pager 6-476, 408-231-0988
fax 408-851-4359, tie line 401
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"Patricia Luptak" <[EMAIL PROTECTED]>
Sent by: 06/01/2006 11:08 AM |
To: "list serve" < cc: Subject: Renal Criteria for PICC line insertion |
I need help from the group on an important issue. I need to know what criteria is in place where you practice on when you hold from using a patient's arm for PICC placement due to renal insuffiency. In addition if anyone has policies, references from journals, literature, etc. please list them as well. I have a nephologist that wants to restrict PICC placement based on creatinine but with our elderly patient population that would severly limit any PICC placement if we went with that number globally. Any help from my colleagues is needed and appreciated in advance
Thanks
Patty
Patty
Patty Luptak RN OCN BSEd
Manager Oncology/Infusion Services @ Jefferson Regional Medical Center
LITE Presidential Advisor
www.lite.org
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