Can anyone direct me to clear guidelenes as to PIV below a fistula. I know this is not acceptable but am being challenged by another RN that is ED based. I need something black and white and have not found anything. Thanks in advance for your assistance and opinions.
Jen
The best reource would be the Kidney Dialysis Outcome Quality inititiave (K-DOQI) guidelines from the National Kidney Foundtation. Not sure if they are definitive enough but for any renal patients, this is the most comprehensive recommendations available. 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
I hope you go your answers from the reference that Lynn gave you. Take that situation and ask questions back of the ER nurse. Ask what the complications are of an IV. Infection, phlebitis, etc. Now ask if the patient would want his fistula affected by an infection or phlebitis that started downstream of his/her fistula. You know we have all seen phlebitis and infection travel right up the veins. The obvious answer is, NO. So best practice would tell as reasonable nurse that you would avoid that arm just like you would avoid same arm in a pt that has had lymph nodes removed.
Now back to the patient. Obviously in a REAL emergency. You are going to have to do what you have to do. With the intensive care doctor present I actually stuck the fistula in a diaysis pt that was unconsious from a very low blood sugar that in the past I was able to get a tiny IV in but now had failed 4 attempts and glucagon had not worked. He continued to deteriorate so the decision was made to push D5W through his fistula. Now this was truly an emergent situation. A central line was later placed.
I am a breast cancer survivor and I don't let anyone stick my right arm. But my best veins are there. If I was really coding I would expect staff to use my best veins to save my life. My left arm veins are very bad and the large ones sclerosed from chemotherapy.
Don't let people put you on the defensive. Stick by what you know is best practice and ask them to explain why they want to do what they want to do. They will remember much better. Show them your reasonableness by saying that in ACTUAL code situations you might have to use whatever vein you can get into and then get better access ASAP. As Lynn will likely tell you, ERs are getting hit with "what is an emergency" when it comes to many things.
Mary Penn RN VA-BC
St Charles MO
I agree with Lynn.
Do not use the arm...period. Unless it's life or death...other than that?...use the neck
Jack Diemer