Re: Renal Criteria for PICC line insertion

[Beth Ferguson]

yes, we can!  I refused to place a picc in a dialysis patient and requested a tunneled IJ. This patient was waiting to have a fistula/graft placement currently with a permcath.  She already had sorry veins.  We need to look out for all of our patients, but dialysis is the lifeline for renal patients until they are transplanted then we still need to preserve their arms when the transplant fails(the life of a transplanted kidney is about 10-15 years). You have a very valid question, are we over-inserting PICCs? I think time will tell and hopefully people are researching this very issue, my immediate answer is yes.  When we can't get access on a patient, the knee jerk reaction is get a PICC. Beth ----- Original Message ----- From: Scott Gilbert To: Beth Ferguson Sent: Sunday, June 04, 2006 2:32 AM Subject: Re: Renal Criteria for PICC line insertion Are we "ruining" vasculature with PICCs?   If a PICC is such a threat to vasculature, and we may "ruin them with a PICC", have we thought about all the other patient's veins generally  "at risk"?    Is it then just "benefit over risk"  for everyone else?     Is it maximum benefit and minimum risk for whom?  Nurses, doctors, or patients?  Are we over-inserting PICCs or carefully screening veins and patients?   Can we ask that physician's of renal patients please stop ordering PICCs and peripheral and IV infusions per UE?   Scott     ----- Original Message ----- From: Beth Ferguson To: Dianne Sim ; [EMAIL PROTECTED] Cc: [EMAIL PROTECTED] ; [EMAIL PROTECTED] Sent: Saturday, June 03, 2006 8:49 AM Subject: Re: Renal Criteria for PICC line insertion DON'T PLACE PICCs IN RENAL PATIENTS! Look out for the longterm needs of these patients even if the doctors don't. These patients will run out of access sites for their dialysis soon enough without us ruining them with a PICC. Beth Ferguson   ----- Original Message ----- From: Dianne Sim To: [EMAIL PROTECTED] Cc: [EMAIL PROTECTED] ; [EMAIL PROTECTED] Sent: Thursday, June 01, 2006 6:16 PM 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     IV Assist, Inc., 2675 Appian Way Pinole, CA  94564 Phone: (510) 222-8403 Fax: (510) 222-8277 Email: [EMAIL PROTECTED]       Confidentiality Notice:  This e-mail and any attachments are intended only for the use of those to whom it is addressed and may contain information that is confidential and prohibited from further disclosure under law. If you have received this e-mail in error, its review, use, retention and/or distribution is strictly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message and any attachments.[v1.0] 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   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 Kaiser Santa Clara –Homestead 710 Lawrence Expressway Infusion Center, Department 440 Santa Clara, California 95051 408-851-4301, tie line 401 Pager 6-476, 408-231-0988 fax 408-851-4359, tie line 401 CONFIDENTIAL OR PRIVILEGED:  This communication contains information intended only for the use of the individuals to whom it is addressed and may contain information that is privileged, confidential or exempt from other disclosure under applicable law.  If you are not the intended recipient, you are notified that any disclosure, printing, copying, distribution or use of the contents is prohibited.  If you have received this in error, please notify the sender immediately by telephone or by returning it by reply email and then permanently deleting the communication from your system. Thank you.   "Patricia Luptak" <[EMAIL PROTECTED]> Sent by: [EMAIL PROTECTED] 06/01/2006 11:08 AM                 To:        "list serve" <[EMAIL PROTECTED]>         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  __________________________________________________ Do You Yahoo!? Tired of spam? Yahoo! Mail has the best spam protection around http://mail.yahoo.com