Re: Potential Dialysis Patients and PICCs

[Leigh Ann Bowe-geddes]

Title: Potential Dialysis Patients and PICCs

Wendy: We don't insert PICCs in patients with renal failure. Even if we had the psychic ability to predict the next fistula site, it is highly possible that would not be the last site. The DOQI Guidelines can be helpful to you in your quest to make the physicians understand the importance of venous preservation in renal patients. If we destroy vessels, they cannot be used for future dialysis access. Most fistulas have a limited life span, and then the patient must have another one created. At some point they can run out of veins, especially if renal failure occurred early in life, and dialysis goes on for years. Tom Vesely wrote an article for JAVA (may have still been JVAD at the time) that addressed the role of PICCs for renal patients. We do not go only on the creatinine level. We always check that. If the patient is in acute RF we make sure that it is resolving before we insert a PICC. If the creatinine is at or approaching 2.0 we delve deeper. We always read the chart to assess the entire situation before making any decisions. Leigh Ann   Leigh Ann Bowe-Geddes, RN, CRNI IV Therapy Specialist Infusion Services Department University of Louisville Hospital Louisville, KY 502-562-3530 >>> "Erickson, Wendy" <[EMAIL PROTECTED]> 9/20/2006 7:51 AM >>> 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. ----------------------------------------------------- Confidentiality Disclaimer This message, including any attachments, is confidential, intended only for the named recipient(s) and may contain information that is privileged or exempt from disclosure under applicable law, including PHI (Protected Health Information) covered under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.  If you are not the intended recipient(s), you are notified that the dissemination, distribution, or copying of this message is strictly prohibited.  If you receive this message in error, or are not the named recipient(s), please notify the sender or contact the University of Louisville Health Care I.S. helpdesk at 502.562.3637 to report an inadvertently received message. -----------------------------------------------------