From the Guidelines
Placing a tunneled Peripherally Inserted Central Catheter (PICC) line in a patient with End-Stage Renal Disease (ESRD) is generally not recommended. The primary concern is that PICC lines can damage veins and cause venous stenosis or thrombosis, which may compromise future creation of arteriovenous fistulas or grafts needed for long-term dialysis access 1. According to the KDOQI clinical practice guideline for vascular access, thrombosis associated with PICC placement can occur in up to 71.9% of patients, highlighting the risk of vein loss and potential complications for future dialysis access 1.
Some key points to consider when evaluating the use of PICC lines in ESRD patients include:
- The risk of central vein stenosis and thrombosis associated with PICC placement, which can limit future access options for hemodialysis 1
- The importance of preserving peripheral and central veins in the upper extremities for maintaining long-term dialysis access options in ESRD patients 1
- Alternative options for central venous access, such as non-tunneled central venous catheters in the internal jugular vein, tunneled dialysis catheters, or ports, which may be more suitable for ESRD patients requiring central venous access 1
In light of these considerations, alternative options for central venous access should be prioritized over PICC lines in ESRD patients, in order to minimize the risk of complications and preserve future access options for hemodialysis 1.
From the Research
Placing a Tunneled PICC Line in ESRD Patients
- The placement of a tunneled Peripherally Inserted Central Catheter (PICC) line in patients with End-Stage Renal Disease (ESRD) is a common practice, despite the potential for significant complications 2.
- Complications associated with PICC lines in ESRD patients include thrombosis, stenosis, and infection, which can lead to substantial morbidity 2, 3.
- The use of PICC lines in ESRD patients is often necessary due to advanced patient age, peripheral vascular disease, and the lack of an interdisciplinary service line for vascular access 2.
- However, recent guidelines recommend avoiding PICC lines in patients with chronic kidney disease (CKD) and ESRD, due to the high risk of complications and the importance of preserving venous access for future hemodialysis 3.
Risks and Complications
- The risk of venous thrombosis associated with PICC lines is relatively high, particularly in the cephalic vein, with reported rates ranging from 23.3% to 38% 4.
- The incidence of thrombosis can be influenced by factors such as catheter size, location, and patient age, although no significant differences were noted in one study 4.
- Other complications associated with PICC lines in ESRD patients include phlebitis, catheter-related infection, and central vein stenosis 3, 4.
Tunneling Technique
- The tunneling technique for PICC line placement has been shown to be a safe and easy alternative to traditional placement methods, with a low risk of complications 5, 6.
- The use of a tunneling technique can help to reduce the risk of infection and improve patient comfort, by allowing for the creation of an exit site at a preselected point on the upper limb 5.
- However, more in-depth studies are needed to evaluate the impact of tunneling on early and late complications associated with PICC lines in ESRD patients 6.