AVshunts

Generally speaking...yes you can use the non functional shunt or graft arm. I say that b/c you really need to be aware of the future plan for the patient. The trend now is to save the upper extremity arm veins for potential future access. PICCs in these pts and in non functional grafts or shunts are not absolutely contraindicated either BUT you need to consult with the nephrologist. Our radiologist are now placing tunneled power lines via the jugular or subclavian veins b/c we insisted they follow the current guidelines and offer our renal pts this option. Yes we still place PICCs in many of our renal pts and yes we place PIVs in these pts as well. Communication between nursing and medicine is essential in these cases as these pts tend to have very limited venous access options and venous preservation is essential. Sometimes the docs do not even think about this and start ordering all kinds of irritating antibiotics....we have to intervene and say lets send them to IR for a power line. Again evaluate risk vs benefit of all your decisions.

It usually depends on the nephrologist, but we do get many patients with bilateral AV fistulas where one does not work, and we are allowed to use that arm for BPs, lab draws and IV's. Again though, it is important to see what your specific unit policies are as well as asking the physicians before anything is done.

FYI PICCS have a lower infection rate than Ports. Unfortunately not all MDS keep up with current research or run the numbers.