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When a patient has both a shunt in one arm and an IV in the other hand, it is crucial to avoid drawing blood from either of these sites to prevent any complications or potential harm to the patient. Drawing blood from the arm with the shunt can lead to disrupting the shunt's function and drawing from the arm with the IV can dilute the sample with IV fluids, affecting the accuracy of test results. In such a situation, it is recommended to perform a capillary stick, which involves obtaining a blood sample from a fingertip or heel. This option allows for obtaining a blood sample without interfering with the vascular access in the arms, prioritizing patient safety and ensuring the integrity of the blood sample for testing.