From the Guidelines
It is not recommended to place an intravenous (IV) line in an arm with a history of arteriovenous fistula (AVF) for dialysis, as this may compromise future vascular access options and increase the risk of complications. When considering IV placement in a patient with a history of AVF, it is essential to prioritize the preservation of vascular access sites for future dialysis needs, as emphasized in the 2019 update of the KDOQI clinical practice guideline for vascular access 1.
The guideline highlights the importance of thoughtful planning and preservation of future dialysis access choices, considering the patient's ESKD Life-Plan. Placing an IV line in an arm with a history of AVF may inadvertently affect the patient's future vascular access options, particularly in younger individuals with expected long survival with ESKD.
Key considerations for IV placement in patients with a history of AVF include:
- Avoiding areas with obvious scarring or abnormal vessel patterns
- Assessing the site for adequate blood flow and absence of collateral vessels
- Using standard IV insertion techniques with appropriate catheter sizes
- Considering alternative sites if resistance is encountered during insertion or if the patient experiences unusual pain
- Using ultrasound guidance if necessary, especially in cases with limited IV access options.
However, the primary concern is preserving vascular access sites for future dialysis needs, and alternative IV placement sites should be prioritized whenever possible, as suggested by the KDOQI guideline 1.
From the Research
Considerations for IV Line Placement in an Arm with a History of Arteriovenous Fistula (AVF)
- The presence of an AVF in an arm may affect the placement of an intravenous (IV) line due to altered vascular anatomy and potential complications such as thrombosis or stenosis 2, 3, 4.
- Studies have shown that AVFs can be successfully created in the arm, including the forearm, using various techniques such as brachial-brachial arteriovenous grafts (BB-AVGs) or upper arm brachiobasilic arteriovenous fistulas (BBAVFs) 2, 5, 6.
- However, the placement of an IV line in an arm with a history of AVF may require careful consideration of the potential risks and complications, including thrombosis, stenosis, or infection 3, 4.
Potential Risks and Complications
- Thrombosis: AVFs can be prone to thrombosis, which may be exacerbated by the placement of an IV line 3, 4.
- Stenosis: AVFs can also develop stenosis, which may affect the flow of blood and potentially lead to complications such as thrombosis or infection 2, 3.
- Infection: AVFs can be at risk of infection, particularly if the IV line is not properly secured or if the patient has a compromised immune system 4.
Guidance for IV Line Placement
- There is limited direct evidence to guide the placement of an IV line in an arm with a history of AVF 2, 5, 3, 4, 6.
- However, it is generally recommended to avoid placing IV lines in arms with AVFs or other vascular access devices to minimize the risk of complications such as thrombosis or infection 3, 4.