Does anyone have any policies/procedures for line placement in the advanced CKD/ESRD patient that they wouldn't mind sharing. We have only vague department "rules" and feel we need to develop a more formal policy.
Thank you
Tammy
Does anyone have any policies/procedures for line placement in the advanced CKD/ESRD patient that they wouldn't mind sharing. We have only vague department "rules" and feel we need to develop a more formal policy.
Thank you
Tammy
I would check this site under Resources. There may be a policy that addresses that that you could use as an example. I would also refer to the INS Standards, and AVA Policy statement regarding CKD patients, and te NKDOQI guidelines on vascular access to form your policy. Usually most places have it in their PICC policy, not a separate policy. Be careful to not make your policy too exclusionary and give your nurses room for critical thinking and clinical judgement. Patients are not black and white, and having a policy for everything is just not possible. Having well trained staff is the answer to provideing best outcome care.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
Our policy is to "Save the Vein" for future dialysis use. That being said, one size does not fit all. Our team has developed a good relationship with the nephrologists at our facility. We will not place a PICC without their approval. Obviously if the pt is a limited code status and has already refused dialysis or other aggressive treatments and needs access for antibiotics, pain medications etc then this may be a separate issue. We are ordering a lot of "small gauge, flexible central catheters in the IJ" ordered as PICCs placed in the IJ (as we don't carry a separate catheter yet) to be placed in the IVR department. They are charted as CVCs. The nephrologists want the smaller gauge softer catheters for their patients that need central access.
Your policy needs to address the general need to preserve veins for dialysis grafting/shunts. The rest is collaboration between your team and the nephrologists as to what is best for each patient. We have been given permission to place peripheral cental access on some patients especially if they have already been assessed in an arm that does not have veins suitable for grafts/etc. And also in some that had a temporary issue that has resolved.
Our collaboration has developed so well that the nephrologist have asked us to educate the other hospitals in the system that are nearby. One of the nephrologists is wanting to know what he can do to get the hospital to help me to get my training to be able to place IJ small gauge soft catheters. It is sometimes difficult to get is scheduled in IVR. It is on my to do list.
Mary Penn RN Vascular Access Team
Mary,
Please write me offline if you are interested in a comprehensive IJ training program specifically for vascular access nurses. [email protected]
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
As a Vascular Access Specialist I would recommend that anyone looking to access veins other than the upper arm, that you take a class that includes teaching more than just the IJ. Don’t limit your options for your patients by adding only one other vien. The right device for the right patient at the right time does not equal IJ or a PICC. If you’re going to expand your skill set take it to your greatest potential! The class I took, with physicians leading the course included accessing the IJ, subclavian/axillary, and femoral. Make yourself invaluable to your patients and your organization.