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Updated: Jan 24, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Use of Peripherally Inserted Central Catheters in Patients With Advanced Chronic Kidney Disease: A Prospective Cohort
David Paje1, Mary A M Rogers1, Anna Conlon2
1University of Michigan Medical School, The Patient Safety Enhancement Program, and Center for Clinical Management Research at VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.P., M.A.R.).
Insights
Peripherally inserted central catheters (PICCs) are frequently placed in hospitalized patients with chronic kidney disease (CKD), despite guidelines recommending against it. This practice is common and contradicts current clinical recommendations.
Area of Science:
- Nephrology
- Internal Medicine
- Vascular Access
Background:
- Clinical guidelines, including Choosing Wisely recommendations, advise against the use of peripherally inserted central catheters (PICCs) in patients with chronic kidney disease (CKD).
- Despite these guidelines, the frequency of PICC placement in hospitalized patients with advanced CKD remains a concern.
Purpose of the Study:
- To determine the incidence of PICC placement in hospitalized patients with stage 3b or greater CKD (eGFR <45 mL/min/1.73 m2).
- To characterize the patient population receiving PICCs and identify factors associated with their use in this cohort.
- To assess the variation in PICC placement rates across different hospital settings and identify associated complications.
Main Methods:
- A prospective cohort study was conducted across 52 hospitals within the Michigan Hospital Medicine Safety Consortium.
- Data were collected on hospitalized medical patients who received a PICC between November 2013 and September 2016.
- Key measurements included the percentage of patients with CKD receiving PICCs, the frequency of PICC-related complications, and the variability in PICC use among CKD patients.
Main Results:
- Over 20,000 patients received PICCs, with 23.1% having an eGFR <45 mL/min/1.73 m2; 3.4% were on hemodialysis.
- PICC placement was more common in intensive care units (30.9%) compared to wards (19.3%) among patients with reduced eGFR.
- PICC-related complications were observed in 15.3% of CKD patients in wards and 22.4% in ICUs, with wide hospital-level variation in PICC use for CKD patients.
Conclusions:
- The study found that PICC placement in hospitalized patients with CKD is common.
- This practice is inconsistent with existing clinical guidelines that recommend avoiding PICCs in this population.
- Further investigation into the reasons for non-adherence and strategies to improve guideline concordance is warranted.
Background:
Existing guidelines, including Choosing Wisely recommendations, endorse avoiding placement of peripherally inserted central catheters (PICCs) in patients with chronic kidney disease (CKD).
Objective:
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).
Design:
Prospective cohort study.
Setting:
52 hospitals participating in the Michigan Hospital Medicine Safety Consortium.
Participants:
Hospitalized medical patients who received a PICC between November 2013 and September 2016.
Measurements:
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.
Results:
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).
Limitation:
Nephrologist approval for placement could not be determined, and 2.7% of eGFR values were unknown and excluded.
Conclusion:
In this sample of hospitalized patients who received PICCs, placement in those with CKD was common and not concordant with clinical guidelines.
Primary Funding Source:
Blue Cross Blue Shield of Michigan and Blue Care Network.
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