The following was originally posted by Kelly Cawcutt, MD, to the University of Nebraska Medical Center Division of Infectious Diseases blog.
PICC placement is common practice for intravenous (IV) antibiotic needs, however, we may be inadvertently placing certain patients at higher risks for complications. A recent study by Paje et al assessed the frequency of PICC placement among patients with CKD stage 3b or greater, a practice discordant with current guidelines. This prospective study included data from over 20,000 adult patients across 52 hospitals participating in the Michigan Hospital Medicine Safety Consortium between 2013 and 2016. The most common indication for PICC placement was for IV antibiotics (37.6%). Of patients with PICCs, 23.1% had CKD stage 3b or greater, with increased likelihood of PICC placement in the setting of CKD within the ICU as compared to the wards (32.1% vs 18.9%, respectively). Further, most PICC lines placed in patients with CKD were removed prior to hospital discharge (67.2%), with 25.8% of these lines having an indwell time of less than 5 days. 17.8% of all PICCs developed complications, with higher rates among those in the ICU and those with CKD. This study is incredibly important as it highlights the need to assess potential risks of placing a PICC, in addition to the need for IV antibiotics, particularly among those with CKD. The high rate of PICC placement among CKD patients limits their future potential for AV fistula placement, the lowest risk hemodialysis access for CLABSI and other complications. Further, the short duration of indwell time in PICCs suggests potential alternative IV access, or potential treatment options, could have been pursued. There is great opportunity for the ID community to improve vascular access device choice, in concordance with current guidelines, among CKD patients requiring antibiotics.
Content originally posted in the IDSA Journal club. Written by Dr. Kelly Cawcutt.