Patients with IVs, Fistulas and AV grafts

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Course Objectives
Define IVs, fistulas, and AV grafts in relation to phlebotomy practice
Recognize risks and complications of drawing near these access sites
Apply correct procedures when collections near IVs are permitted
Explain why fistulas and AV grafts must never be used for routine blood draws
Course Content
Course Creator: Kirsten Hermens NCMA-P
Total CE Hours: 1 Credit Hour 
Pace Course #: 586-2421-25
Outline:
  • Introduction
    • Importance of safe technique with specialized vascular access
    • Purpose: safety, accuracy, preservation of access, staying within scope
  • Key Terminology
  • Lesson Roadmap
    • IV Sites – safe procedures & nurse collaboration
    • Fistulas – identification & restrictions
    • AV Grafts – recognition & risks
    • Policies & Scope – rules & guidelines
    • Case Scenarios – applying knowledge
  • Collecting from IV Sites
    • What IV sites are & why they complicate venipuncture
    • Differences: IV site, IV line, implanted port
      • Other vascular devices: PICC, CVAD (off-limits)
    • Who draws what: phlebotomist vs nurse
    • When not appropriate (restricted tests, viable alternatives)
    • Tests never drawn near IV (PT/aPTT, cultures, drug levels)
    • Quick safety checks & hard stops
    • Correct method for drawing distal to IV (tourniquet, nurse pause, documentation)
    • Required documentation examples
    • Case Scenarios: IV Lines
      • Key takeaways: opposite arm first, never line access, restricted test rules
  • Arteriovenous (AV) Fistulas
    • Definition & significance as dialysis lifeline
      • Terminology: fistula vs AV fistula vs graft
    • How to recognize: rope-like vein, thrill, bruit
    • Why fistulas are off-limits (infection, clotting, vessel loss)
    • Phlebotomist responsibilities: identify, avoid, document, collaborate
    • Patient scenarios (fistula alert, compromised access)
    • Communication with dialysis staff (timing, coordination, documentation)
    • History & evolution of AV fistulas
      • Key takeaways: recognition, absolute protection, historical significance
  • AV Grafts
    • Definition & placement
    • Graft vs fistula: differences in material, maturity, risks
    • Risks: infection, clotting, repeat surgeries
    • Advantages vs Disadvantages
    • Recognition: palpable tube/loop, scars, thrill/bruit
    • Why grafts are off-limits
    • Phlebotomist role: recognition, no-stick protocols, documentation
      • Key takeaways: protect grafts as patient lifelines
  • Career Growth: From CPT1 to Dialysis Tech
    • Why transition matters (expanded skills, pay, responsibility)
    • Core dialysis technician skills (machine setup, monitoring, sterile technique)
    • Training & certifications:
      • CCHT (NNCC)
      • CHT (BONENT)
      • California CHT (CDPH requirement)
  • Policies, Scope & Clinical Protocols
    • Facility policies (always follow site-specific rules)
    • National standards: OSHA, CLSI, Joint Commission, CAP
    • Scope of practice: what CPT1s can/cannot do
    • Documentation as a legal/clinical shield
    • Best practice summary: safety, scope, documentation
  • Case Scenarios (Application)
  • Lesson Review & Recap
 
References: 
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  2. (2018, May 7). Phlebotomy Top Gun: Drawing Blood from a Patient Receiving Intravenous Fluids. Mayo Clinic. Retrieved August 21, 2025, from https://news.mayocliniclabs.com/2018/05/07/phlebotomy-top-gun-drawing-blood-from-a-patient-receiving-intravenous-fluids/
  3. (n.d.). Peripheral IV. Cleveland Clinic. Retrieved August 30, 2025, from https://my.clevelandclinic.org/health/treatments/24930-peripheral-iv?
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  6.  Kinshella, A. L. (2025). The Foundations Of Modern Phlebotomy (1st edition). Intelvio, LLC.
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  8. (n.d.). Dialysis Fistula. Cleveland Clinic. Retrieved August 21, 2025, from https://my.clevelandclinic.org/health/procedures/dialysis-fistula
  9. (n.d.). Bruits And Thrills What Was That. Nursing Center. Retrieved August 30, 2025, from https://www.nursingcenter.com/blogs-plus/blogs/blogs-post?identifier=bruits-and-thrills#/post/bruits-and-thrills
  10.  (n.d.). Arteriovenous Fistula. National Library Of Medicine. Retrieved August 30, 2025, from https://www.ncbi.nlm.nih.gov/books/NBK559213
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  15.  (n.d.). Clinical Practice Guidelines and Clinical Practice Recommendations. Kidney Foundation. Retrieved August 31, 2025, from https://kidneyfoundation.cachefly.net/professionals/KDOQI/guideline_upHD_PD_VA/hd_guide3.htm
  16. (n.d.). Hemodialysis Vascular Access: A Historical Perspective on Access Promotion, Barriers, and Lessons for the Future. Science Direct. Retrieved August 31, 2025, from https://www.sciencedirect.com/science/article/pii/S2590059524000827#
  17. The First Arteriovenous Fistula: A History of Hemodialysis Access and a Forgotten Pioneer Misskey, Jonathan et al. Journal of Vascular Surgery, Volume 61, Issue 6, 81S https://www.jvascsurg.org/action/showPdf?pii=S0741-5214%2815%2900626-6
  18. (n.d.). Vascular access for hemodialysis: Current perspectives. National Library Of Medicine. Retrieved August 31, 2025, from https://pmc.ncbi.nlm.nih.gov/articles/PMC4099194/
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  21. (2017, November 15). Important Facts about Arteriovenous Grafts. Azura Vascular Care. Retrieved August 31, 2025, from https://www.azuravascularcare.com/infodialysisaccess/arteriovenous-graft-facts/#
  22. (n.d.). Differences Between AV Graft & Fistula: Advantages & Disadvantages. Laminate Medical. Retrieved August 31, 2025, from https://www.laminatemedical.com/2020/03/08/differences-between-av-graft-and-fistula-advantages-and-disadvantages/
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