Peripheral IV starts in dialysis pts

[pm80]

While talking to a coworker the other day the subject of starting a peripheral IV on the same extremity as a dialysis pts fistula or shunt came up. We know it's not allowed but we were not sure why exactly. I guess we mustve missed that day of class.

I know it would be less than optimal. I can understand how a fistula could alter the pathway of a med push but the blood would still get back to the heart to be redistributed. So , other then for a drug like adenosine, why would it be banned outright? What about a pt. in arrest? If the only descent vein you can find is in the same extremity as their port then why couldn't you use it?

Thanks for your help and sorry if this is a dumb question.

[traumaRUs, MSN, APRN]

If the pt is in arrest, use the access. If the pt needs a peripheral IV for non-emergent or non-coding situation, why not use the other arm? The dialysis access is their lifeline so it is never a good idea to use the affected arm if something else is available.

[diabo, RN]

In a true emergency, timing is important, but the access arm should be used only as a last resort. Any stick could potentially effect the access, or might limit the effectiveness of a future access. The same goes for taking blood pressures in the access arm. Clotting in many cases is cumulative and may not happen right away. There are good reasons for this long standing rule. Perhaps your nephrologist can shed some more light.