# Blood Draw from hand of fistula extremity



## Medico (Mar 8, 2017)

I understand why you do not apply a BP cuff or tourniquet over a fistula; avoid circumferential compression. I also understand why you do not obtain IV access in the same extremity. But, why can't you obtain a blood draw via a butterfly in the hand, either with a tourniquet applied to the wrist or with no tourniquet at all.

The only sources I can find reference applying cuffs and tourniquets over the fistula.


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## E tank (Mar 8, 2017)

Anonymous internet response to a patient care issue, here...but... an IV or a blood draw in the same hand as an AV fistula or even dialysis graft is OK. No reason to stick someone there if you have a choice somewhere else just because of the riot you might cause though, IMO. 

 Nephrologists might have kittens over it, but that's because those things are out of their competency. The vascular surgeons that put them in and manage them when they go down don't have an issue with that (I've spoken to 6 of them specifically about this). 

Non issue, or should be.


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## VFlutter (Mar 8, 2017)

Dialysis patient always have fantastic veins on the side of their AV fistula and no where else.... Avoid it at all cost but if the patient is in extremis you do what you have to, just expect to hear some push back. I see absolutely no issue obtaining labs from a vein in the hand on the same side as a fistula but I would still avoid IVs.


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## Handsome Robb (Mar 10, 2017)

Would there not be an issue with lab values being skewed due to mixing of venous and arterial blood distal to the AV fistula? 


Sent from my iPhone using Tapatalk


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## VFlutter (Mar 10, 2017)

Handsome Robb said:


> Would there not be an issue with lab values being skewed due to mixing of venous and arterial blood distal to the AV fistula?
> 
> 
> Sent from my iPhone using Tapatalk



Potentially but most common labs do not have a huge difference in venous vs arterial.


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## E tank (Mar 10, 2017)

Handsome Robb said:


> Would there not be an issue with lab values being skewed due to mixing of venous and arterial blood distal to the AV fistula?



Not at all. With the exception of blood gasses, arterial and venous blood is identical in terms of commonly measured tests. Even an arterial blood gas sample distal to a normally functioning A-V fistula should be the same as the side without the fistula. You can partially demonstrate that by checking O2 sats on both hands. They should be identical if the fistula is working properly.


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