Which condition is a contraindication to performing venipuncture in an upper extremity?

• A. Weakness
• B. Paralysis
• C. AV fistula or graft
• D. Infection at site

Answer: (C)

Preserve dialysis access and protect the arm used for that access. An arteriovenous fistula or graft is the lifeline for hemodialysis, and needle punctures there can damage the vessel, precipitate infection, bleeding, or thrombosis, and compromise the patient’s ability to receive dialysis. Because of that, venipuncture in an arm with a fistula or graft is avoided.

Weakness or paralysis isn’t an automatic barrier to drawing blood; you’d choose the safest available site, usually the opposite arm. An infection at the site would prevent puncturing that exact spot, but the strongest, most definitive reason to avoid venipuncture on an upper extremity in this scenario is the presence of a dialysis access.