How many of you ever stick the non-access arm for any reason? Like to use as a venous return if needed, for labs, IV's?
Why would you recommend this be done or not done?
What about saving the viens for future vascular access sites?
Comments?

I was taught way back when ( I have been in dialysis for 25 years) to use peripheral veins if there was nothing else available and it was a dire emergency. Like a patient with a really high K+ or one who's in full blown pulmonary edema.

These days I know we are being taught to protect the patient's vessels to keep them viable for a possible future access.

I still think in a dire emergency we should go ahead and use a peripheral vein. Better to do that than have a dead patient with good veins.

3 reasons we would stick non-access extremities on the unit:
1. Recirculation studies - we utilize an Arterial, Venous and Peripheral blood sample.
2. Pt came in for labs on a nontreatment day, as we do not stick grafts/fistulas for lab specimens. Although, we will use their catheter, if they have one.
3. (for nondialysis patients) Plasmapheresis therapy using peripheral needle sites. Although, we will use their catheter, if they have one.

Pts also get blood drawn from the non-access extremities in the clinics and hospitals.

We do hear more and more about saving vessels for future use, especially with our dialysis clinic working hand in hand with the IV therapy team at the local hospital.

However, do you not believe that it truely applies to those persons who are stuck very frequently (daily/multiple times per day), have IV catheter placements/removals frequently and for frequent plasmapheresis therapy with peripheral sticks using steel needles.

There is a movement, here anyway, to decrease the # of sticks for inpatients to as low as possible, when possible. So we draw blood with IV starts, when possible. We attempt to maintain IV catheters for as long as possible. We promote the use and early placement of PICC, Groshong, Multimedlines, Vas Caths and other appropriate CVCs for those clients who will be on long term IV drug therapy.

We also push for large bore IV catheter placement for venous return during plasmapheresis. This way, we stick arterial only for the first several treatments and then swap extremities.

I hesitate to say that when a patient needs blood drawn, use their access, because the use of that access by personel who don't understand it, could lead to its loss. And that access is our patient's life line. I've had patients return to out-patient treatments with pressure dressings and pt's stating that they had blood drawn from the access..."2 days ago..." That is very scary, it doesn't take long to clot off an access...fistula or graft.

Reasons to stick and then what to do as an option:
1. Acute dialysis with high K+ or pulmonary edema- well how about a femoral catheter if an vein would be used.
2. Recirculation studies- never stick the non access arm. Recirc studies should be done using the DOQI Guideline 12 (now many ways to get recirc % without a lab draw such as the Transonics or Crit-line. See web site www.kidney.org DOQI Guideline #12). The �peripheral� stick is no longer from a vein in the non access arm.
3. Plasmapheresis patients should have proper catheters placed to avoid damage to the vessels- they might be at high risk for ESRD depending on the other disease leading to the need for plasmapheresis.
4. Blood draws- non access arms stuck for blood draws can be the reasons the arm is not usable for a dialysis access when needed. See DOQI Guideline # 7. Protect the cephalic veins- can use the hands. A dialysis patient should be able to have all needed labs done on dialysis days and drawn via the access. Coordination of needed labs from other MD can be done and results given to the ordering MD. Have the patients bring to dialysis a script from the lab ordering MD and just draw the blood in dialysis and then forward to the lab for processing- this way the dialysis unit only draws the blood. The ordering MD must cover the cause/diagnosis codes needed for reimbursement of the lab. Most local hospitals will set up a lab pick up at your dialysis unit like they do for MD offices. You can get a lock box and call when a pickup is needed. Try giving a copy of the most recent labs to patients prior to MD visit such as Primary Care MD�s, Family MD�s or any other MD the patient sees for care. Patients can tell the dialysis unit the treatment before they see the other MD and hand carry copies of the labs or have the unit fax copies of the most current labs-can also communicate current medication list and other important dialysis information. Some units use a communication sheet that the MIS or computer system can print out and use for MD visits.
5. Acute labs done with hospital admissions can also be coordinated with dialysis treatments with only needed STAT labs done on the general nursing floor with hand draws only. If the importance of the vessel preservation is understood- it is much more likely to occur.

I asked this question because this is a common complaint for vascular surgeons that try to create a fistula and find the vessels too damaged by previous needle/IV sticks. Wonder how we work together as a renal community to help save our patients veins so they can b fistula lifelines? What do you all think. The last 2 posts cover the most common reasons we might stick a vein. What other reasons did we miss?

Where do we start and whom do we educate, the hospital staff, dialysis staff, patient? I think we need to educate everyone that works with pre-ESRD and ESRD patients and the patients. Comments?