American Society of Nephrology

View all recommendations from this society

Released April 4, 2012

Don’t place peripherally inserted central catheters (PICC) in stage III-V CKD patients without consulting nephrology.

Venous preservation is critical for stage III–V CKD patients. Arteriovenous fistulas (AVF) are the best hemodialysis access, with fewer complications and lower patient mortality, versus grafts or catheters. Excessive venous puncture damages veins, destroying potential AVF sites. PICC lines and subclavian vein puncture can cause venous thrombosis and central vein stenosis. Early nephrology consultation increases AVF use at hemodialysis initiation and may avoid unnecessary PICC lines or central/peripheral vein puncture.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Society of Nephrology (ASN) maintains a Quality and Patient Safety (QPS) Task Force that advances ASN’s commitment to providing high-quality care to patients and to raising awareness of patient safety issues for all professionals administering care to kidney patients. Each of ASN’s 10 advisory groups contributes expertise to the task force to ensure it addresses all areas of nephrology practice, and the society’s president, public policy board and council also provide insights. The QPS task force centered its focus on five items most likely to positively impact and influence optimal patient care. The final list of five items was unanimously approved by the ASN public policy board and council. ASN’s disclosure and conflict of interest policy can be found at www.asn-online.org.

Sources

Fistula First Breakthrough Initiative – National Coalition Recommendation for the Minimal Use of PICC Lines, American Society of Diagnostic and interventional Nephrology: Guidelines for Venous Access in Patients with Chronic Kidney Disease, Seminars in Dialysis, National Kidney Foundation Clinical Practice Guidelines for Vascular Access, The Renal Network, Inc. PICC Line Resource Toolkit, Clinical and Experimental Nephrology.