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Mary J. Matteson
A-V Graft
Several days ago I submitted to the forum and my colleagues were unable to respond for whatever reason. I will restate the issue to see if the experts can respond.I was asked to place a Rt. (short) Picc which was written in error.  Was supposed to be a lft. Picc so a surgeon could use my Picc to create a A-V Graft in a pts. left arm.  I had never heard of this and refused to do it,  which as you can imagine created unrest with the physicians!!  Pt. is ESRD has been receiving dialysis since mid Dec  (hemodialysis).  His was tried on peritoneal dialysis but has not been effective. So a permanent graft for hemodialysis is going to be necessary.  The pts. creatinine this day was 7.0.  I feel this procedure would be contrindicated and our INS standards would not support this procedure.  Comments?  Please!  MJM
We are considering becoming
We are considering becoming a heparin free facility.  Can I get some input on literature that is evidence based?
Michael Drafz
Sounds like the surgeon

Sounds like the surgeon doesn't know what the definitions of these line are. When you say "short PICC" I am assuming he is talking about a Midline. This would be technically difficult to do, since they are usually placed at the ac or above, if he wanted to use it to do the venogram (which dye shouldn't be given via Midline either) you would have to make this a very short Midline to be low enough for him to place the graft above. Unless you would wanted to put it in the forearm.....(I wouldn't suggest). Anyway this seems the only explanation I can think of why he would like it in the same arm.....Why not just place a PIV in the forearm?


Michael Drafz RN, CRNI, VA-BC

Clinical Lead Vascular Access Service

Sharp Metropolitan Medical Campus

San Diego, CA


Mary, I am a dialysis nurse


I am a dialysis nurse with 28 years experience, and this is the first time I have heard of such a thing! You were right to refuse. A patient should never have any IV lines in the dialysis access arm. An AV graft is a synthethic material in which one end is sutured to a vein and the other to an artery. An AV fistula is using the native vein and artery to produce a vessel with high blood flows. Some years ago, most fistulas were placed in the forearm, but an increasing number are put in the upper arm because of the need for higher blood flows on dialysis. I am completely perplexed about this surgeon's reasoning, as I am sure he had access to high tech flouroscopy for vein mapping that you did not. I also worked on an IV team for several years and now manage dialysis, IV therapy and renal transplant. I also see our unit as progressive, but have never seen this. You may contact me personnally if you have further questions.


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