David Paje, MD, MPH; Mary A.M. Rogers, PhD, MS; Anna Conlon, PhD; Scott A. Flanders, MD; Steven J. Bernstein, MD, MPH; Vineet Chopra, MD, MSc
Financial Support: Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network provided support for HMS as part of the BCBSM Value Partnerships program. Although BCBSM and HMS work collaboratively, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees. Dr. Chopra is supported by grants from the Agency for Healthcare Research and Quality.
Disclosures: Dr. Flanders reports personal fees from Wiley Publishing, expert testimony, and grants from BCBSM and the Agency for Healthcare Research and Quality outside the submitted work. Dr. Chopra reports grants from Agency for Healthcare Research and Quality during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2937.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: Available from Dr. Chopra (e-mail, firstname.lastname@example.org). Statistical code: Available from Dr. Rogers (e-mail, email@example.com). Data set: Not available.
Corresponding Author: Vineet Chopra, MD, MSc, University of Michigan, 2800 Plymouth Road, Building 16 #432W, Ann Arbor, MI 48109; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Paje: Division of Hospital Medicine, 1500 East Medical Center Drive, F-4309 UH-South Unit 4, Ann Arbor, MI 48109-2435.
Dr. Rogers: North Campus Research Complex, 2800 Plymouth Road, Building 16 #400W, Ann Arbor, MI 48109-2800.
Dr. Conlon: North Campus Research Complex, 2800 Plymouth Road, Building 16 #410E, Ann Arbor, MI 48109-2800.
Dr. Flanders: North Campus Research Complex, 2800 Plymouth Road, Building 16 #422E, Ann Arbor, MI 48109-2800.
Dr. Bernstein: North Campus Research Complex, 2800 Plymouth Road, Building 16 #420E, Ann Arbor, MI 48109-2800.
Dr. Chopra: North Campus Research Complex, 2800 Plymouth Road, Building 16 #432W, Ann Arbor, MI 48109-2800.
Author Contributions: Conception and design: D. Paje, S.A. Flanders, V. Chopra.
Analysis and interpretation of the data: D. Paje, M.A.M. Rogers, A. Conlon, S.J. Bernstein, V. Chopra.
Drafting of the article: D. Paje, V. Chopra.
Critical revision of the article for important intellectual content: D. Paje, M.A.M. Rogers, S.J. Bernstein, V. Chopra.
Final approval of the article: D. Paje, M.A.M. Rogers, A. Conlon, S.A. Flanders, S.J. Bernstein, V. Chopra.
Statistical expertise: M.A.M. Rogers, A. Conlon, V. Chopra.
Obtaining of funding: V. Chopra.
Collection and assembly of data: D. Paje.
Existing guidelines, including Choosing Wisely recommendations, endorse avoiding placement of peripherally inserted central catheters (PICCs) in patients with chronic kidney disease (CKD).
To describe the frequency of and characteristics associated with PICC use in hospitalized patients with stage 3b or greater CKD (glomerular filtration rate [GFR] <45 mL/min/1.73 m2).
Prospective cohort study.
52 hospitals participating in the Michigan Hospital Medicine Safety Consortium.
Hospitalized medical patients who received a PICC between November 2013 and September 2016.
Percentage of patients receiving PICCs who had CKD, frequency of PICC-related complications, and variation in the proportion of PICCs placed in patients with CKD.
Of 20 545 patients who had PICCs placed, 4743 (23.1% [95% CI, 20.9% to 25.3%]) had an estimated GFR (eGFR) less than 45 mL/min/1.73 m2 and 699 (3.4%) were receiving hemodialysis. In the intensive care unit (ICU), 30.9% (CI, 29.7% to 32.2%) of patients receiving PICCs had an eGFR less than 45 mL/min/1.73 m2; the corresponding percentage in wards was 19.3% (CI, 18.8% to 19.9%). Among patients with an eGFR less than 45 mL/min/1.73 m2, multilumen PICCs were placed more frequently than single-lumen PICCs. In wards, PICC-related complications occurred in 15.3% of patients with an eGFR less than 45 mL/min/1.73 m2 and in 15.2% of those with an eGFR of 45 mL/min/1.73 m2 or higher. The corresponding percentages in ICU settings were 22.4% and 23.9%. In patients with an eGFR less than 45 mL/min/1.73 m2, PICC placement varied widely across hospitals (interquartile range, 23.7% to 37.8% in ICUs and 12.8% to 23.7% in wards).
Nephrologist approval for placement could not be determined, and 2.7% of eGFR values were unknown and excluded.
In this sample of hospitalized patients who received PICCs, placement in those with CKD was common and not concordant with clinical guidelines.
Blue Cross Blue Shield of Michigan and Blue Care Network.
Paje D, Rogers MA, Conlon A, et al. Use of Peripherally Inserted Central Catheters in Patients With Advanced Chronic Kidney Disease: A Prospective Cohort Study. Ann Intern Med. 2019;171:10–18. [Epub ahead of print 4 June 2019]. doi: https://doi.org/10.7326/M18-2937
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Published: Ann Intern Med. 2019;171(1):10-18.
Published at www.annals.org on 4 June 2019
Chronic Kidney Disease, Hospital Medicine, Nephrology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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