What is the recommendation for peripheral IV placement in dialysis patients with AVF and AVG? I am a Vascular Access RN and I was taught never to use the extremity with the AVF or AVG. I place PICC lines also. We commonly refer dialysis patients to Nephrology for a tunneled PICC. But recently, we are being told we can place a Peripheral IV in the arm with the AVF/AVG as long as it is below the access. I am not comfortable with this and want to know what the NKF position is on this practice. I am also the wife of a dialysis patient with an AVG in his right upper extremity. I will not allow blood draws or PIV's in that arm or blood pressures per what I have been taught.
Post date: February 10, 2014
I have permitted peripheral IV access in the back of the hand on the same side as the AV fistula. I do not permit IV access above the wrist on the same side as the fistula. I do not permit Peripherally Inserted Central venous Catheters (PICC) access to be placed in any dialysis patient with a fistula. I only permit centrally lines in the Right Internal Jugular position. The KDOQI guidelines recommend right sided central venous catheters, avoiding subclavian catheters and avoiding peripheral IV access in any dialysis patient or pre-dialysis patient. They also mention using the back of the hand veins for peripheral access but avoiding the arm veins for peripheral IV access.