Patient lacks peripheral access for therapeutic phlebotomy. The staff has been able to perform it using an implanted port with limited success. The patient was referred to vascular surgeon, who recommended an AV fistula. Does anyone have patient experiences using this device for this purpose? The INS policies and procedures 4th ed. suggested an apheresis catheter for this purpose.
I have no experience in this but think it's a brilliant concept. I've researched the topic of using fistulas for infusion and found a couple of referrences where they have been used for chemo and tpn. When you think about it., lots of drugs are given during dialysis, antibiotics in particular.
I have twice accessed AV fistulas in a code when nothing else was available. Once I saw a nephrologist directly access a shunt to push D50 as we just could not get an IV in emergently.
There potential to solve the problem of vascular access could be huge.
I applaude the surgeon who is thinking out of the box.
Darilyn
I had working AV fistula[grafts] working for over 12 yrs, and they were the only access for any IV need. be it labs, TPN or anaesthesia, due to poor PIV status.For me I would use a normal butterfly 21 needle for the labs, stab in, and then the lab staff would connect the vial to the end of the tubing. take the blood and then leave me to remove the needle
Things to think of is that the bevel point and angle should be going with the flow , so that the flap closes down afterwards, and doesnt cause a notch on the inside [esp graft] [debirs will build up]
For longer accessing I used an angiocath, as its important that a hard metal needle is not used when the patient is moving around, so either the dialysis splinting must be part of the hard needle policy.
when removing needle since the flows match arterial then, definitely 3mins of pressure and be prepared to do 10min
All access of an AV MUST be done in a sterile /aseptic manner.
The horror of an infected AV graft is terrible for the patient