title: Institution of a Hospital-Based Central Venous Access Policy for Peripheral Vein Preservation in Patients with Chronic Kidney Disease: A 12-Year Experience.
abstract: OBJECTIVE
  To describe the implementation of nursing-based venous access team (VAT) and standardized interventional radiology (IR) protocols in accordance with Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines to provide central venous access while preserving peripheral veins in patients with chronic kidney disease (CKD).
  
  
  METHODS
  Review of peripherally inserted central catheter (PICC) and small-bore central catheter (SBCC) referral and placement data from VAT and IR databases was conducted over a 12-year period. SBCC referral was automatic for patients with creatinine levels ≥ 3 mg/dL or a renal transplant regardless of creatinine level unless dialysis was not planned. All SBCC insertions, regardless of referral source, were identified and reviewed, and SBCC placements prompted by K/DOQI PICC contraindication were identified. Catheter types, indications, access sites, technical success, and complications were ascertained.
  
  
  RESULTS
  A total of 35,781 requests for PICC placement were made to the VAT; 1,889 (5%) were referred to IR for SBCC placement per institutional policy, and 2,200 SBCCs were attempted or newly placed during this period, 1,879 (85%) based on K/DOQI contraindications. Primary indication for SBCC placement was antibiotic therapy (59%). Access sites included right internal jugular vein (IJV) (70%), left IJV (24%), right external jugular vein (EJV) (3%), left EJV (2%), right common femoral vein (CFV) (0.3%), and left CFV (0.2%). Technical success rate of SBCC insertion was 99%. Six minor (0.3%) and three major (0.1%) complications occurred.
  
  
  CONCLUSIONS
  Automatic referral for SBCC placement in patients with CKD via VAT and IR protocols may eliminate PICC placement and thereby protect peripheral veins needed for hemodialysis. SBCC placement has high technical success and low complication rates.
authors.affiliation: Department of Radiology and Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia; Department of Radiology and Division of Vascular and Interventional Radiology, University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: Jeffrey Forris Beecham
authors.initials: JF
authors.lastname: Chick
authors.affiliation: Department of Radiology and Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia; Radiology Associates of the Main Line and Division of Vascular and Interventional Radiology, Main Line Health System, Bryn Mawr Hospital, Bryn Mawr, Pennsylvania.
authors.forename: Shilpa N
authors.initials: SN
authors.lastname: Reddy
authors.affiliation: Department of Radiology and Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Yam
authors.affiliation: Department of Medicine and Division of Nephrology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia.
authors.forename: Sidney
authors.initials: S
authors.lastname: Kobrin
authors.affiliation: Department of Radiology and Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia. Electronic address: scott.trerotola@uphs.upenn.edu.
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D015415:Biomarkers / Q000097:blood; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D003404:Creatinine / Q000097:blood; D004867:Equipment Design; D006801:Humans; D018579:Patient Selection; D015397:Program Evaluation; D015641:Radiography, Interventional; D012017:Referral and Consultation; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures
chemical_list: D015415:Biomarkers; D003404:Creatinine