From the Guidelines
Intravenous lines should be placed in the dorsum of the hand in patients with chronic kidney disease to preserve arm veins for potential vascular access, as recommended by the most recent and highest quality study 1. When considering the placement of intravenous lines, it is essential to prioritize the preservation of veins for potential vascular access, particularly in patients with chronic kidney disease.
- The study published in the American Journal of Kidney Diseases 1 emphasizes the importance of preserving arm veins, especially the cephalic veins of the nondominant arm, to maximize the chances of successful arteriovenous fistula placement and maturation.
- The use of subclavian vein catheterization for temporary access should be avoided in patients with kidney failure due to the risk of central venous stenosis, as highlighted in the study 1.
- In contrast, more recent studies, such as the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) 1, provide guidance on the appropriateness of different types of intravenous catheters for various indications and durations of use. However, these studies do not supersede the recommendation to preserve arm veins in patients with chronic kidney disease, as this is a critical consideration for long-term vascular access.
- The MAGIC study 1 suggests that peripheral intravenous catheters, ultrasonography-guided peripheral intravenous catheters, and midline catheters are preferred over peripherally inserted central catheters (PICCs) for patients with difficult venous access when the expected duration of use is 14 or fewer days.
- Nevertheless, the primary concern in patients with chronic kidney disease remains the preservation of arm veins for potential vascular access, and intravenous lines should be placed in the dorsum of the hand to achieve this goal, as recommended by the study 1.
From the Research
Types of Intravenous Lines
- Peripheral intravenous lines are used for emergency and intensive medical care, and have a high importance in primary care and early stages of treatment initiation 2
- Central intravenous lines, including peripherally inserted central catheters (PICC) and midline catheters, are used for patients who require long-term intravenous therapy 3
- PICC lines and midline catheters have different indications, insertion techniques, and management requirements 3
Management and Maintenance of Intravenous Lines
- The insertion, use, and maintenance of peripheral and central intravenous lines require specific skills and knowledge to prevent complications and ensure patient safety 4
- Site selection, skin preparation, securement, and maintenance and removal criteria are critical aspects of intravenous line management 4
- Infection control is a crucial aspect of intravenous therapy, and nurses play a key role in preventing infection associated with intravenous therapy 5
Complications and Risks Associated with Intravenous Lines
- Intravenous lines are associated with risks of thromboembolic and infectious complications, including deep venous thrombosis (DVT) and sepsis 3
- The rates of DVT and sepsis were found to be similar between PICC and midline catheters in a retrospective review of 3560 patients 3
- Common complications of intravenous therapy include infection, thrombosis, and mechanical complications, and strategies can be implemented to prevent these complications 5
Nurse Knowledge and Education
- Critical care nurses may have limited knowledge of the requirements for specific intravenous administration lines for medications regularly given in critical care 6
- There is a need for easy-to-access information and education on the interactions of critical care intravenous medications and administration line materials, protection from light, and filtration 6