Drawing Blood - page 3

by fat cat 20,541 Views | 27 Comments

I had a situation where a particular patient had such bad veins that I as well as several other nurses were unable to obtain it. However several days later a nurse working with this patient who had E.R. experience drew the... Read More


  1. 0
    Quote from jmgrn65
    How in the world can you access an artery without a Doctors order, that is way more dangerous than the foot.
    I wondered about that too.
  2. 0
    I've drawn from the foot before in psychiatry without an order. I didn't know any better at the time, and I was an aide.
  3. 4
    Hi Nurses, I had bi-lateral mastectomies with many lymph nodes removed from each side.
    Soon thereafter I developed Lymphedema in both arms and across my chest. The danger
    of infection, in my arms and chest, is high.

    Blood draws were from my port-a-cath until BC treatments were completed. From now
    on all blood draws, as well as blood pressure cuffs and IV's are done from my feet. (I do
    not have diabetes.)

    I find foot blood draws far less painful than arm ones. During this 5 yr journey and due
    to other health issues I have dealt with many MDs and Phlebotomists in 2 states. Each
    MD understands, the Phlebotomists are about half yes and half no. I've learned to make
    sure that I have the order, with me, when I go to a lab and to call, the lab, to verify that
    they know what is necessary before I show up and that someone is there that can do it.

    None of this is fun. I did everything right. Mammograms each year starting at age 40.
    One morning at age 60 I wake up with a breast that was totally deformed. I got a
    mammogram that day it came back clear. I went to my family MD who called a
    surgeon as soon as she saw the breast. He said it is cancer, took a needle biopsy,
    it came back clear.

    He was screaming at the Pathologist knowing that my breast was full of cancer. He
    opened the breast, took out some meat, and found that I had a rare BC that is rarely
    detected by any current methods and it had been growing for probably 15-20 years.
    As well as likely to go to the other breast. It was staged at IIIc. The story goes on
    and on but you get the picture.

    So, mastectomies, lymph nodes/glands, then lymphedema.....are we having fun yet???

    I am not in the medical field but my Daughter is an RN. I thank each of you for all you do.
  4. 0
    OK.... someone PLEASE explain to me why you would need an order to draw from ANY peripheral Vein? In our kiddos, all veins are the same, arms, legs, scalp--- whatever works. Why whoud you not draw a lab in a lower extremity in an adult? I do not remember this from school- I am curious!
  5. 0
    Quote from PICNICRN
    OK.... someone PLEASE explain to me why you would need an order to draw from ANY peripheral Vein? In our kiddos, all veins are the same, arms, legs, scalp--- whatever works. Why whoud you not draw a lab in a lower extremity in an adult? I do not remember this from school- I am curious!
    This is an old thread .. but still interesting.

    I never heard of needing an order to draw from a foot or start an IV in a foot.

    And I have used the foot for blood draws and IV starts.

    steph
  6. 0
    Quote from PICNICRN
    OK.... someone PLEASE explain to me why you would need an order to draw from ANY peripheral Vein? In our kiddos, all veins are the same, arms, legs, scalp--- whatever works. Why whoud you not draw a lab in a lower extremity in an adult? I do not remember this from school- I am curious!
    I work in peds as well. The answer I have been given from my peers as to why they don't do lower extremities as often in adults is due to risk of sticking a tendon instead of a vein. Don't know how great that risk actually is.
  7. 2
    Adults have poorer circulation than infants and children. With lower extremity sticks the risks for clots and infection is much greater, and if it infiltrates, the complications are more severe due to the circulation issues.

    Think about it--walk down the typical med/surg hallway. The vast majority of the pts are over 60, have multiple health problems, and every one of them has PVD, diabetes, or artherosclerosis (or all three). That's why you can't do a stick in the lower extremities without an order from an MD. In ER, ICU, and in nursery and peds, this rule does not usually apply (though in my hospital, tICU hast to get an order from the MD, too).
    reidob and PICNICRN like this.
  8. 0
    I concur that foot blood draws and IVs should be a very last resort. They are done rather often in our clinic (we deal with a lot of IV drug users who have "burned" their best veins), but I think the use of leg and foot veins is sometimes simple laziness. There are often hand or even less convenient arm veins that are accessible, but because the addict is less likely to use leg veins, we go for the easy stick. I worked ICU for 10 years before coming to this clinic, and we never used leg veins. Personally, I refuse to do so. It is my perception that the risk of clotting or occlusion is simply far too great in those areas. If a patient needs a blood draw that badly, we can do a radial artery stick, and if they need an IV that badly, they probably belong inpatient, where a central or PICC line can be placed. (I obviously disagree with the person who felt that the risk of harm was greater with an arterial stick). I think we are setting our patients up for problems and ourselves up for liability if we use lower extremity veins. In any case, I would never, ever draw from a lower extremity without an explicit order, to cover myself.


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