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PICC insertion in arm with non -functioning dialysis fistula

I am a PICC nurse in a medical center in Norteast PA.We have been asked repeatedly by a Renal transplant surgeon to insert PICC lines in his post transplant patients, most of whom have had arm fistulas and Tesio caths pre-transplant. We have tried to explain our reasons for refusing to place PICC lines in an arm that has been compromised by fistulas or graftrs but he feels it's not an issue. How can we convince this surgeon that we are correct in refusing to place these lines?? Also, what are the guidelines for inserting a PICC on the same side as a Tesio cath--I can't imagine that it would be an ideal situation.

The porblem lies not with

The porblem lies not with the fact that an arm has an old fistula in it but, that the patient is a greater risk for renal failure in the future, due to rejection. KDOQI guidelines specify that the arm and subclavian veins should be preserved for future use in the event of renal failure. Now prior to the quidelines coming out I have put a line in an arm with an old fistula in it (very difficult wouldn't recommend it).

Jeffery Fizer RN, BSN

Having come from a dialysis

Having come from a dialysis RN background of ~ 4 yrs prior to my current position as an Infusion RN, I understand KDOQI guidelines regarding preservation of veins for future use as related to renal failure.  However, as a PICC RN I also understand that renal patients, as you all know are notorious for poor peripheral vein status, and are often times stuck multiple times unsuccessfully for peripheral access.  Our PICC team is often consulted from floor RN's for Midline or PICC placement for dialysis pts.  We have placed Mid/Picc Lines in extremities where abandoned graft/fistula reside, and although very difficult @ times, isn't that better than the alternative of a pt being stuck multiple times unsuccessfully?  When a Tesio present, why can that not be used as access as long as physician gives order to do so?

I would seriously hesitate

I would seriously hesitate and send out strong warnings about using any hemodialysis catheter for routine infusions of any kind. These catheters may be needed for infusion in an emergent situation but routine use is not good. This routine use increases hub manipulation and blood reflux, thereby increasing the risk of CRBSI and lumen occlusion. As you know from your dialysis background, high flow rates are critical for these catheters. Frequent use would greatly jeopardize these flow rates. CDC guidelines state use of dialysis only!

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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