DOES ANYONE HAVE SUGGESTIONS REGARDING PICC INSERTION IN PATIENTS WITH A CREATININE LEVEL OF 2 OR HIGHER?

OF COURSE, THIS MEANS, PATIENTS WHO HAVE HISTORY OF RENAL PROBLEMS, AND NOT AN ACUTE RISE IN CREATININE LEVEL DUE, SAY, TO DEHYDRATION OR CURRENT ILLNESS, AND IS EXPECTED TO RETURN TO NORMAL.

OUR DOCS IN INTERVENTIONAL RADIOLOGY WANT TO RAISE THE LEVEL TO 3, WHILE SOME OF THE NEPHROLOGISTS ARGUE THAT A LEVEL OF 2 OR HIGHER IS INDICATIVE OF FUTURE RENAL PROBLEMS AND POSSIBLE A-V GRAFTS NEED.   SOME OF THE NEPHROLOGISTS RECOMMEND A TUNNELED LINE, TO SAFEGUARD THE PATIENTS' ARM VEINS.  AS PICC NURSES WE ARE SOMEWHAT CAUGHT IN THE MIDDLE.  WE WILL ASK FOR A NEPHROLOGIST'S CONSULT BY PHONE, AND WILL INSERT THE LINE IF WE HAVE PERMISSION.  IT HAS HAPPENED, THOUGH, THAT WE HAVE GOTTEN PERMISSION EVEN WITH A LEVEL OF 6.  SHOULD WE BE MORE PROACTIVE, AS PATIENT'S ADVOCATES, AND REFUSE TO INSERT PICC LINES?

WHAT DO YOU DO AT YOUR FACILITY?

THANKS FOR ANY SUGGESTION.  MARIA

 

In my institution, IR,

In my institution, IR, Renal Services and PICC services decided that pt w/ createnine greater then 2.0 ,that seem to be heading towards Renal failure, will require Renal Fellow or attending to approve PICC insertion.

The physician ordering the PICC discuss the issue w/ Renal Fellow (or Attending) and if they approve a PICC insertion the ordering physician writes in his note who from Renal service approved the insertion.

I find this arrangement very agreeable and it has worked very well for us.

We defer to the

We defer to the nephrologists- usually they say no to the PICC, although in some instances they are okay with it. It's their call.

Thanks for responding.  I

Thanks for responding.  I will certainly check out the JAVA summer issue.

Maria

JAVA Summer 2007  has an

JAVA Summer 2007  has an article in it re: vein preservation

There is an excellent

There is an excellent discussion of this topic in the summer AVA journal 

(I'm pretty sure it was the summer issue, don't have my journals here to check)