Receiving fluids or medications intravenously is a common medical procedure, involving a small, flexible tube placed into a vein. For individuals requiring long-term treatments like hemodialysis, the choice of where to place an intravenous line is a significant consideration. A vascular fistula, a specially created access point, is a crucial component of their ongoing care. Protecting this access point is paramount for their health and continued treatment.
Understanding Vascular Access
An arteriovenous (AV) fistula is a surgically created connection between an artery and a vein, typically in the arm. This procedure allows arterial blood to flow directly into a vein, causing it to enlarge and thicken over several weeks to months. This strengthened vein provides a reliable access point for hemodialysis, a treatment that filters waste products from the blood when kidneys no longer function adequately. The AV fistula is the preferred method for long-term hemodialysis access due to its durability, lower infection risk, and less clotting compared to other access types. A properly functioning fistula can be identified by a palpable vibration, known as a “thrill,” and a whooshing sound, called a “bruit,” both of which indicate strong blood flow.
Why IVs Are Not Placed in a Fistula Arm
Placing an intravenous line in an arm with a functioning fistula is avoided due to serious risks that can compromise its integrity and the patient’s long-term health. Puncturing the fistula can lead to scarring, narrowing (stenosis), or blood clots (thrombosis). These issues impede blood flow, potentially rendering the fistula unusable for dialysis. Losing a functional fistula can severely impact a patient’s ability to receive life-sustaining dialysis treatments, often necessitating new access procedures that can be complex and deplete available vein sites.
There is also an increased risk of infection. A fistula is a direct connection to the bloodstream, and any breach of the skin provides a pathway for bacteria, potentially leading to a localized or widespread bloodstream infection. Infections are particularly dangerous for dialysis patients, who often have compromised immune systems. Additionally, placing an IV can cause pain and bleeding, and the resulting damage can compromise future treatment options. Healthcare guidelines emphasize preserving vascular access sites for future dialysis needs, making it crucial to avoid any actions that could harm a functioning fistula.
Safe Alternatives for Intravenous Access
Since the fistula arm is reserved for dialysis access, healthcare providers prioritize alternative sites for intravenous lines. The most common alternative is the patient’s non-fistula arm. Peripheral intravenous lines can be placed in veins on the back of the hand, forearm, or inner elbow of the unaffected arm. These sites are suitable for administering fluids, medications, or blood products for short to moderate durations.
If peripheral veins are not viable or if long-term or specific types of intravenous access are needed, central venous catheters (CVCs) may be considered. These catheters are placed in larger veins, often in the neck, chest, or groin, and include types such as Peripherally Inserted Central Catheters (PICC lines) or temporary central lines. While CVCs provide reliable access, they carry risks, including a higher chance of infection compared to fistulas, and are considered when peripheral access is challenging or insufficient.
Protecting Your Fistula
Patients with a vascular fistula play a significant role in its preservation and continued function. Always inform all healthcare staff, including emergency personnel, about the presence of your fistula. Wearing a medical alert bracelet or tag that clearly states “No Blood Pressure/IV/Blood Draws on this Arm” is an effective way to communicate this information, especially if you are unable to speak for yourself.
Avoid having blood pressure cuffs, blood draws, or intravenous lines placed on the arm with the fistula. Regularly check your fistula by gently feeling for the “thrill” (vibration) and listening for the “bruit” (whooshing sound); any changes in these sensations, or their absence, should be reported to your healthcare team immediately. Keeping the fistula arm clean, protecting it from injury, and avoiding tight clothing or jewelry on that arm also contribute to its longevity. Protecting the fistula is essential for maintaining consistent and effective dialysis treatment.