At my company, which was pretty Large, they said you never point either needle down in a graft. I don't know the reasoning, but I looked up the guidelines and it says that arterial needle can be faced up or down on an AVF and an AVG. I am not sure why I was taught differently. Here is the link with some guidelines about dialysis accesses. http://www.bcrenalagency.ca/NR/rdonl...nnulation1.pdf
Whatever iron medication you use, could also be Venofer or Ferrlicit, among others, it is important to push this medication very slow. We used to dilute it in a bag of saline and give over one hour. After budget cuts were made, they did away with the small saline bags and we just had to hook up the medication and push one ml at a time. I didn't like that practice. This drug is known to do funny things to blood pressure, both drop it and make it higher, depending on the persons body chemistry. Epogen is contraindicated in people with chronic hypertension, however, you will rarely see it held. Supposedly, it increases the risk of strokes. I think most doctors say that the risk of stroke is very low and not worth making someone chronically anemic and feeling awful. We never held iron meds for blood pressure though. I floated to many different clinics. Maybe it is your doctors preference to be more careful with this med. Can you ask the charge nurse?