I agree here. It is best, in my opinion, for everyone (primary care provider, nephrologist, vascular access nurse, etc.) to work together. Each patient is unique and what works best for some does not work for everybody.
Tim Royer, RN, BSN, CRNI Nurse Manager / Vascular Access / Diagnostic Service VA Puget Sound Health Care System Seattle, WA > 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 > PICC Service Coordinator > Luther Midelfort - Mayo Health System > Eau Claire WI > ********************Confidentiality Notice******************** > > > > This message is intended for the sole use of the individual and entity to > whom it is addressed, and may contain information that is privileged, > confidential and exempt from disclosure under applicable law. Any > unauthorized review, use, disclosure or distribution of this email > message, including any attachment, is prohibited. If you are not the > intended recipient, please advise the sender by reply email and destroy > all copies of the original message. Thank you. > > > > --------------------------------- > Yahoo! Messenger with Voice. Make PC-to-Phone Calls to the US (and 30+ > countries) for 2ยข/min or less.
