David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
Published guidelines recommend avoiding PICC placement in patients with CKD as part of a strategy to preserve veins for future hemodialysis access. However, this study showed that almost a quarter of all PICC lines were placed in patients with stage 3b CKD or higher (estimated glomerular filtration rate < 45 mL/min/1.73m2).
The authors speculate that gaps in provider knowledge and awareness may be partly responsible—providers may be unaware of the recommendations against PICC use for these patients or of the degree of CKD present.
The authors suggest that reducing PICC use in this population will require system-based solutions that might range from electronic decision support (e.g., at the point of order entry) to consultative vascular access services that can assist with access decisions in complex patients.
An editorial emphasizes the importance of vein protection for patients with CKD and suggests that education of the broader medical community will be critical to achieving these goals.
These data show a high rate of opioid use in hospitals and a clear association between in-hospital opioid prescription and future use. The authors suggest that this association could be a target for interventions to reduce opioid use and dependence.
The study has a few limitations. It was limited to a single hospital system, and the classification of patients as opioid naive may have been imperfect. Also, there was no effort to determine the appropriateness of opioid therapy.
An editorial suggests that the results of this study may provide an impetus to avoid prescribing opioids to hospitalized patients. The editorialists highlight the difficulty of balancing the goals of adequate pain control and patient satisfaction with the risks of increased long-term opioid use.
Wesorick DH, Chopra V. Annals for Hospitalists - 16 July 2019. Ann Intern Med. 2019;171:HO1. doi: https://doi.org/10.7326/AWHO201907160
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Published: Ann Intern Med. 2019;171(2):HO1.
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