Have a patient with a still functioning left upper arm AV fistula that is still being used for dialysis. Patient also has a right wrist maturing AV fistula. Pt. needs power injection of CT contrast, our radiology dept. will not use a peripheral EJ for power injection. It is a weekend and our IR dept. is not in house to place a tunneled cath and the primary team does not want to place a CVL. What is our best option out of all of our not so optimal choices? Thanks
I can totally understand and strongly agree with your radiology dept about doing power injection through a PIV in the EJ - far too dangerous for extravasation. A tunneled catheter is overkill for only one power injection. Have you spoken with the nephroglogist about the situation and discussed the possibility of using a PIV in one of the upper extremities. For what reason was a 2nd fistula placed? Could you find a vein in the left forearm if this site is not anticipated to be used for dialysis much longer? What is the possibility of using a site well above the new one in the rigth wrist? I would first discuss this with the nephrologist and go from that discussion. If neither arm is possibile then your only choice is a subclavian or IJ CVC. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you, Lynn.
We are developing a midline policy. Do any other institutions restrict midline placement to a patient that's been afebrile for 48 hours?
Thank you,
Kristi
Not sure why a patient on dialysis would agree to the risk of receiving contrast. Contrast is cleared through the kidneys and giving contrast to a patient in this situation could be harmful and possibly fatal. Do the study without contrast or get an MRI or other study to evaluate the problem.
The MD may not realize the test ordered requires contrast, or may not realize that this patient is on dialysis. There are rare occasions where a dialyisis patient is given studies with contrast, but in those cases they require dialysis IMMEDIATELY after the test, to remove all contrast from their bloodstream.
Looks like a conversation needs to start.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC