Peripheral central catheter insertion in low eGFR patients: Retrospective single institution study.

ABSTRACT

PURPOSE: To identify the rate of Peripherally Inserted Central Catheter (PICC) placement in patients with chronic kidney disease (CKD), stage 3B or higher (glomerular filtration rate (eGFR) <45 mL/min/1.73 m2). MATERIAL AND METHODS: A retrospective study of 2825 adult patients (male 51.2%, female 48.8%) who had a PICC insertion from January 2017 to December 2019. The data collected includes gender, eGFR value at the date of insertion, accessed vein and side, ongoing or subsequent dialysis within 1 year, and death within 1 year of the insertion date. The study excluded pediatric patients, patients with missing eGFR values prior to the procedure and follow-up information. RESULT: PICC insertion was done in patients with eGFR⩽45 mL/min/1.73 m2 in 26.7% (724/2709) of the sample. Ongoing dialysis was documented in 10.2% (198/1946) and subsequent dialysis in 6.5% of the patients within the year after insertion. The overall death rate for the year post PICC insertion was 38.7% (1094/2825), which was significantly higher in low eGFR patients (413/724, 57%) compared to patients with eGFR>45 mL/min/1.73 m2 (632/1985, 31.8%) (p-value < 0.0001, odds ratio 2.84 (95% confidence interval 2.38-3.38)). The rate of dialysis initiated in the year post PICC insertion was 5.9% (98/1657). This was significantly higher in patients with a low eGFR and not previously dialyzed (59/310, 19%) compared to patients with eGFR>45 who required dialysis in the year post insertion (39/1347, 2.9%) (p < 0.0001, odds ratio 7.88 (95% confidence interval 5.14-12.07)). CONCLUSION: PICC insertion in patients with CKD is practiced frequently. Rigorous strategies should be implemented to improve adherence to clinical practice guidelines and reduce unnecessary insertions and preserve veins for when an AVF may be required.