Has anyone ever used a native AV fistula for routine access and IV antibiotic infusion?
Went round and round regarding a patient yesterday and today with history of renal transplant so functioning fistula isn't being used for dialysis. Patient needs at least 4 weeks IV antibiotic tx for infected hip prosthesis then surgery to replace. Went to OR yesterday for tunneled cath but surgeon unable so he placed an IJ TLC that was looped caudally onto itself and therefore useless (removed postop). Vascular surgeon recommends using AV fistula which ID doc, attending and myself disagree with. Patient had PICC that developed thrombus in other arm - we evaluated for possible PICC in arm with AV fistula but no acceptable veins present. I have an awesome team and we are going to try to maintain peripheral access through the weekend but know long term peripheral is not realistic. So options are very limited! Anybody have any thoughts or recommendations on the AV fistula usage? I know this is not appropriate but has anyone ever seen it done? Thanks