Quote from MLB55
Also, he had a RUE dvt. Which is the lesser of the two evils ?
Oof. This is
a tough scenario.
Dialysis patients are notoriuous for IV/CL access nightmares. So many of them not only have an extensive history of fistula/graft placements and revisions, central (dialysis) cath placements, but crap vasculature anyway.
An Art line in an extremity with a functioning fistula/graft will likely produce inaccurate readings due to diverted arterial blood flow (depending on a few factors).
The DVT in the other arm...not an uncommon occurence in patients who have or have had a central line: it can cause central venous stenosis. Attempting to put a line in (for infusion purposes) an extremity with a known DVT is a bad idea.
Attempting a PICC in the dialysis graft arm, is just plain stupid if a picc is not absolutely necessary. PICC's can cause infection, CVC stenoses/clots and thereby compromise future prospects for surgical revision intervention (i.e., basillic vein transposition) on a dialysis access if that access were to fail at some point...
...dialysis access is the patient's long term lifeline
, and every time there is an insult/compromise their vasculature, it is risking future availability of options. Remember, dialysis grafts/fistulas are prone to failure, which is why you might see patients come through with multiple revision/surgeries.
Once they've run out of access options, that can be the end of the road for some.