Shima Goswami MD, Presenter: Nothing to Disclose

Rosanne DeAngelis, Abstract Co-Author: Nothing to Disclose

Maryna Kuznetsov MD, Abstract Co-Author: Nothing to Disclose

Suken Shah MD, Abstract Co-Author: Nothing to Disclose

Jeffrey L. Lautin MD, Abstract Co-Author: Nothing to Disclose

Determine the effect of tunneled peripherally inserted central venous catheter (PICC) lines on central vein patency in patients with chronic kidney disease (CKD).

A prospective trial involving adults (>18 years old) who have CKD (GFR less than 30) and require long-term, non-dialysis, venous access. 5-French Bard Power PICC lines with small anchoring Dacron cuffs were placed under ultrasound and fluoroscopic guidance. Patients had an ultrasound prior to catheter placement and at removal to document jugular vein size, respiratory variation with Doppler waveforms, and imaging of the innominate vein patency. A paired t test was performed to analyze the data.

Fifty-two patients from our institution were enrolled into and completed the study over an 18 month period. Three patients died from unrelated causes prior to catheter removal and ten were lost to follow-up. Of the remaining 39 enrollees there was an 8.8 percent risk of developing narrowing of the central veins greater than 60 percent of the original diameter post tunneled PICC (3/39 patients, p=0.002). Furthermore, of the patients whose central veins remained even partially patent, only four even developed webs in the central veins post tunneled PICC, a proportion of patients so small as to not render them statistically significant (p=0.028).

The data supports our null hypothesis that central vein patency is rarely sacrificed in the setting of tunneled PICC line insertion. Considering the frequent need for tunneled and non-tunneled dialysis catheters in patients with CKD, tunneled catheters can be used safely for long-term, non-dialysis, venous access while preserving peripheral arm veins for dialysis access. 

Tunneled catheters allow preservation of peripheral arm veins in patients who will likely require future dialysis access and our data confirms central vein patency.

Goswami, S, DeAngelis, R, Kuznetsov, M, Shah, S, Lautin, J, Patency of Central Veins in Dialysis Patients with Tunneled PICC Lines.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14000577.html