If a patient has a nonfunctional arteriovenous (AV) shunt in one arm and a functional shunt used for dialysis in the other, does the avoidance of an IV access in the arm with the nonfunctional shunt still apply?

If the extremity with the nonfunctional shunt were used for IV therapy, would this impact any future plans for using that extremity for a shunt if the patent one fails?

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I have always been taught that the affected arm should not be accessed. However, if both extremities are excluded due to shunts, available IV access is a huge challenge. — Peggy Guin, PhD, ARNP, Gainesville, Fla.

It is acceptable to use the arm with the nonfunctioning AV fistula for IV access. However, care must be taken not to use the specific vein that is occluded (typically, the cephalic or basilic vein). Carefully examine the vein, and complete a vascular duplex ultrasonography study for patency and flow. If the vein is suitable in size/caliber but has questionable patency, consider placing an AV graft.

Aside from the cephalic and basilic veins, other veins in the arm and hand are usable for IV access. If the IV is temporary, veins in the feet or ankles are alternative points of access. A portable ultrasonography or a vascular Doppler at bedside may assist in vein location and identification for difficult cases.—Debra August King, PhD, PA (154-10)