For those not familiar with the KDOQI Guidelines for Vascular Access:
NKF K/DOQI GUIDELINES 2000
Guideline 2, Table III-1 indicates rationale for use on non-dominant arm: "To minimize negative impact on quality of life, use of the nondominant arm is preferred"
Preservation of Veins for AV Access
A. Arm veins suitable for placement of vascular access should be preserved, regardless of arm dominance. Arm veins, particularly the cephalic veins of the nondominant arm, should not be used for venipuncture or intravenous catheters. The dorsum of the hand should be used for intravenous lines in patients with chronic kidney disease. When venipuncture of the arm veins is necessary, sites should be rotated. (Opinion)
B. Instruct hospital staff, patients with progressive kidney disease (creatinine >3 mg/dL), and all patients with conditions likely to lead to ESRD to protect the arms from venipuncture and intravenous catheters. A Medic Alert bracelet should be worn to inform hospital staff to avoid IV cannulation of essential veins. (Opinion)
C. Subclavian vein catheterization should be avoided for temporary access in all patients with kidney failure due to the risk of central venous stenosis. (Evidence)
Rationale Venipuncture complications of veins potentially available for vascular access may render such vein sites unsuitable for construction of a primary AV fistula.
Patients and healthcare professionals should be educated about the need to preserve veins to avoid loss of potential access sites in the arms and to maximize chances for successful AV fistula placement and maturation. Subclavian vein catheterization is associated with central venous stenosis.20,26,102 Significant subclavian vein stenosis will generally preclude the use of the entire ipsilateral arm for vascular access. Thus, subclavian vein catheterization should be avoided for temporary access in patients with kidney failure.
Regards,
Daphne Broadhurst
Ottawa ON
Jennifer Prentice <[EMAIL PROTECTED]> wrote:
Jennifer Prentice <[EMAIL PROTECTED]> wrote:
__._,_.___
we have a nephrologist who specifically will check which arm is dominant and
write for the PICC to be placed in that arm for that patient...but he so
rarely will agree with a PICC consult that we check his signature to make
sure it's not a forgery...Jen
>From: Lynn Hadaway <[EMAIL PROTECTED] tes.com>
>Reply-To: [EMAIL PROTECTED] s.com
>To: "Cheryl Kelley" <[EMAIL PROTECTED] net>, "Czapracki, Denise"
><[EMAIL PROTECTED] are.org>, "venous" <[EMAIL PROTECTED] edu>
>CC: <[EMAIL PROTECTED] s.com>
>Subject: [vascular] Re: PICCs and Creatinine levels
>Date: Fri, 22 Sep 2006 14:42:24 -0400
>
>My understanding from the DOQI Guidelines is the concern over
>thrombosed subclavian veins that would increase the difficulty with
>insertion of a large hemodialysis catheter. I don't recall if DOQI
>says anything about dominant vs non-dominant. Lynn
>
>At 1:47 PM -0400 9/22/06, Cheryl Kelley wrote:
> >I thought that the restriction for PICC placement in renal patients
> >had more to do with possible thrombosis of the peripheral veins,
> >espc. the basilic and cephalic veins. That is why a PICC should be
> >avoided in the nondominate arm and if necessary, place the PICC in
> >the dominate arm. Fistulas, grafts, etc. are usually placed in the
> >non dominate side.
> >
> >Thanks,
> >Cheryl
>
>
>--
>Lynn Hadaway, M.Ed., RNC, CRNI
>Lynn Hadaway Associates, Inc.
>126 Main Street, PO Box 10
>Milner, GA 30257
>http://www.hadawaya ssociates. com
>office 770-358-7861
>
>[Non-text portions of this message have been removed]
>
