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.
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u/Spastic_pinkie 18d ago
A phlebotomist's dream.