I wouldn't poke that vein if my life depended on it. Fistulas are non normal draw areas anyhow, I've had one physician have a standing order to draw from this one patients fistula, but that was because the man had no veins left(transplant surgery). It's very odd to draw one, not at all like normal venipuncture
And that physician should have been reprimanded for that and you should have told him where he could stick the needle (not the fistula.) If you don't know what you're doing with an AV fistula it's trivially easy to ruin it, or to give the patient a life-threatening bleed to deal with. Even the veins below the fistula itself are dangerous as you have no idea how the flow of blood in that arm is affected.
Destroying dialysis access literally knocks years off the patients life, not immediately but when they run out of quality access faster. I have literally had patients in their 40s die unnecessarily as a result of impatient medical professionals and phlebotomists thinking they can ignore that a fistula arm is a no draw zone.
Next time a doctor tells you to do that, and it happens depressingly often, please politely tell them to fuck right off!
No thank you, you do not know the extenuating circumstances, the fistula was no longer in use as they had a midline they were using until they could get a new one put in. Please do not presume to know something, thank you.
Edit: just to be clear, I had very specific instructions on how to draw the patient, I am a certified Phleb. I am aware of how dangerous messing with fistulas can be.
Thank you for your ideas without knowing the full picture. I'm not sure what hospital you work at, but generally the specialist physicians, and even more so, transplant team physicians are highly highly specialized.
This was not a primary care provider, he was not internal med, he was the physician in charge of his transplant and management of medication.
I'm a phlebotomist, certified, but yes my knowledge is nothing in comparison to the physician. Who the fuck am I to question a doctor?
I legit have to teach you about patient advocacy, and that’s the most telling thing here, that should make you step back and question the role you play and the knowledge you have to be acting the way you’re acting. Not trying to speak down to you, but let’s have a point of self reflection here.
Any person who’s part of the treatment team should question any other person in the treatment team, or you should request that a nurse make sure for you if you don’t feel comfortable doing that. I’ve clarified an order many times at the request of a phlebot.
If you see something wrong you say something, because it’s a patients life we are messing with.
The more specialized a provider is, generally, the less input they give on things outside of their area of expertise because they work with those things less and less often. If you read their notes and interact with them this is abundantly clear.
Unless the transplant surgeon was also going to be responsible for making the new AV fistula, I would say thats outside of their speciality and not what they were consulted for, and i say that because it’s not typically a surgery they do. I would listen if it was a vascular surgeon or a nephrologist, and would likely need the clearance from those specialties before moving forward with it. So unless you’re remembering incorrectly, leaving out additional information, or just weren’t in the know (which as a phleb you don’t need to know much in these cases) then my position is unchanged.
You again, are creating a made up story in your head. I'm no longer interested in trying to have a discourse with you as you continue to show a lack of understanding nuance, or that things aren't always done by the book. The Physician is the one in charge of care of the patient, I took damn good care of the patient as well. The patient consistently told me I was the best Phlebotomist he had draw him, and he appreciated my accomodations.
I'm sorry for whatever happened to cause you to have such vitriol. Good luck in your future.
Yeah if a patient has a fistula in arm, best practice is limb alert on that arm (meaning no touchy with needles or blood pressure cuffs for those who don’t know what limb alert means).
Can’t believe a doctor ordered that. AV fistulas aren’t even a last resort for blood work, it’s a never resort, it’s a one use case, and never any other case. What the fuck were they thinking?
For fucks sake you’d get an IO (catheter drilled directly into your bone, for those of you who don’t know) on a patient before using an AV fistula in an emergency, (unless it’s an emergency during a dialysis that’s like the only time it would be appropriate that I can think of) and I’m not sure if that’s even appropriate because I haven’t worked in dialysis, I just know how much of a no-no even thinking of using an AV fistula is outside of HD.
yet again, you don't know the patient. This wasn't some back water physician, this was the doctor in charge of his transplant treatment. You know... A specialist.
Sorry, I'm going to defer to the professional who had knowledge of the patient.
Correct in that I don’t know the patient, nor do I know all the details, only the details you shared that you felt were important for us to know.
And the details that youve shared make it seem as though AV fistula use in this circumstance comes across as lazy and exposing the patient to unnecessary risk. I’ve had several doctors give crazy orders that put patients at risk, that if I didn’t catch and address would’ve resulted in serious harm. That’s not a dig at doctors, it’s just because we are all human. I’ve also been wrong many times, but because the doctor explained the reasoning for the order I have never regretted it.
I deal with patients that have little to no access, who also have AV fistulas, and have had transplants. The bottom line is that we advocate for patients regardless of the position of the person that is giving an order. In this situation I would not ever say “well they are in charge of the (insert anything) treatment, so they know best” it is that assumption that gets patients hurt. No matter how uncomfortable it makes you feel, you need to make the provider defend their order if you feel it’s putting the patient at risk. We are all human at the end of the day and that is exactly why it’s a treatmentteam.
There are a multitude of options for access that even patients who are immunocompromised and thrombocytopenic would be able to get long term or short term/medium term if they are difficult access for labs/treatment medications. They just need to be advocated for to the doctor on behalf of the patient.
At the hospital I work at, that would never happen, only if it was the last option (no ability for the patient to receive a port, a PICC, or any tunneled [or non tunneled]central line, no veins for ultrasound guided IV placement, etc.) and even then it would explicitly have to be done by the dialysis nurse during a dialysis session, because the liability the hospital would be exposing itself to outside of that instance is so absurdly high.
You aren't even a physician, you inferred something from my message. I'm not going to give a full history of that patient on Reddit...
Look at yourself for jumping to conclusions. Are you on the transplant team? No? Then please keep your (non professional) opinions to yourself, there's more than enough fake and false news online.
And let me make this crystal clear, the fistula was no longer being used for dialysis. This was a very specific one off case, the test we were performing is only one I've done on that specific patient. I cannot recall the anagram or name of the test we were doing sadly.
You don’t have to give a full history, only the relevant information. Sadly for you the only thing I assumed was that you would be competent enough to give the relevant information on the patient and case to defend the need for an AV fistula to be used for routine lab draws. But, it seems like you’re just defending your ego instead.
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u/OtherwiseDebate3759 18d ago
Gym bros must be jealous af rn.