Line Selection Guideline for Nephrology Patients

Patient < 10 kg NO YES YES Surgery to place small bore tunneled vs non-tunneled CVC (IJ approach pending size and expected duration of therapy; surgeons preference for side)Does patient havean existing port or HDcatheter? YES PIV is an option ?Duration oftherapy LONG PIV (if possible to increase PIV stability/life) in dominant arm (preferred; if unsure of hand dominance, place PIV in RIGHT> left upper extremity )0-5 d6-14 da)Long PIV (pt./family to understand may need repeated PIV placement), vsb)Surgery to place small bore non-tunneled CVC (IJ approach)(***Midline catheter only with discussion/approval by Nephrology attending)YES NODoes patient have a HD catheter OR do you anticipate HD catheter placement in Next 2 wk? UPPER EXTREMITY PICC (either side OK)–once HD catheter removed, considerreplacing HD catheter with CVC & removing PICC Access port –OR -use order sets to allow HD catheter use** **HD catheter use OUTSIDE of dialysis unit OK a) nurses on select floors (A4N, PICU) OR by select nursing staff [VAT team], and b) for select needs -Blood draws, short course (< 5days) IV medications &/or TPN NO *This guideline is intended for the non-emergentCVC request (i.e. access for TPN, lab draws, IVF/IV antibiotics).In emergent situations (sepsis/hypotension), ideal CVC placement would be upper extremities. Placement of Lower extremity CVC should include discussion with member of transplant surgery team. ***Discussion with nephrology attending & transplant surgeons for access options (UE PICC, midline, CVC) If more access is needed 15-60 d (or) red infusateSurgery to place small bore non-tunneled CVC (IJ approach, pending expected length of therapy and current clinical situation); (***PICC only with approval by nephrology attending) NO *** this situation is intended for a) the rare CKD patient where is has been discussed & documented that he/she would not be considered a candidate for future Renal Replacement Therapy (i.e. dialysis, transplant), and/or b) extremely difficult access situations. Use of a midline or PICC requires a verbal discussion with the family of risks as well as verbal discussion & approval by the nephrology attending to the VAT team nurse a)Surgery to place small bore non-tunneledCVC (IJ approach)b)***Only with approval by Nephrology attending: PICC vs midline, with no preference for right vs left upper extremitya)Surgery to place small bore non-tunneled CVC (IJ approach)b)***Only with approval by Nephrology attending: PICC, with no preference for right vs left upper extremity< 14 d15-60 d Surgery to place small bore tunneled CVC (IJ approach) > 60 d > 60 daysSurgery to place tunneled CVC (IJ approach)