We have many patients who are dialysis patients with either a fistula in the arm or a dialysis catheter. Since the affected arm where the fistula is shouldn't be accessed for IV's and the 'good arm' doesn't have a vein left to stick,  what are other institutions doing for obtaining IV access. Our ER have at times placed PIV's on the lower arm with the fistula because the ER physician has okay'd this and the renal doc has said it is okay for a limited time. The renal floor of our hospital feels this is not an okay practice. What are others doing for these renal patients when the fistula or dialysis catheter isn't being accessed for infusions? The question for a plan of care specifically for the renal patient needing IV access is coming up at a care coucil meeting and if anyone has ideas I would greatly appreciate your input. Thanks.