Wendy,
There is an article by Dr. Tom Vesely, who is on the board of AVA, and Dr. Saad who I believe is a Nephrologist. It is in the Winter JAVA 2003. Title is Venous Access for Renal Failure patients. Our practice is that PICCs are contraindicated in Renal and Pre- renal patients. We work closely with the Nephrologists here to protect their patients veins. And yes it does sometimes require a crystal ball in determining who may or may not end up on dialysis. We would rather spare the vein than have them all occluded for when the patient may need fistula's for dialysis. Our Vascular surgeons appreciate this also.
I don't really like the just saving the non dominate arm theory, because I have seen to many dialysis patients end up with multiple fistulas due to infection, clotting or whatever in both arms.
We don't have a specific cut off number for
creatinines, but anyone with an elevated creat, usually has a nephrologist on consult and I call them and let them make the call, if the patient truely needs long term access.
Our Special procedures department places tunneled jugular catheters for some of these patients in order to spare them from PICC's or subclavian lines.
Hope this helps. If you need a copy of the article, I can fax it to you.
Julie
Julie Bryant RN CRNI
Clinical Coordinator
PICC/Midline Dept.
St. Vincent's Medical Center
"Erickson, Wendy" <[EMAIL PROTECTED]> wrote:
Last week at the AVA conference we heard a speaker indicate that a contraindication for a PICC is a patient with a creatinine greater than 3. Our docs have asked us to avoid the non-dominant arm for PICCs - which sometimes requires a crystal ball, as to who might end up on dialysis. Having something more concrete like the creatinine level would be much better for us. Is there any reference or study out there that backs this up? I know I will need ammunition when I approach the nephrologists and surgeons, beyond "I heard it at a conference"!Thanks in advance!Wendy Erickson RN********************Confidentiality Notice********************
PICC Service Coordinator
Luther Midelfort - Mayo Health System
Eau Claire WI
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