Drawing blood from a foot?

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    Hey guys. I'm a new grad RN working on a Med-Surg unit. I was taking care of a woman on a heparin drip. She had a portal vein thrombosis and DVT in the left thigh. I needed an anti-Xa level on my patient around 2300. I get in report that she's an incredibly hard stick, she has a low IV site on the right arm for the heparin infusion (policy is that we can't draw above the IV site). I go in there searching for veins, she's bruised all over and after 1 failed attempt I get some blood from a bruised site in her left arm. Poor thing. I tube the blood to the lab around 2230, call them back around 2300 for the result and they tell me they can't find the blood specimen! GREAT. Round 2. I go back in...I fail, I get two other nurses to draw and they both fail. We call the ED to see if they can send an experienced tech up but they can't. I call the doctor and he tells me to try her feet. Fortunately, this works! But the resource nurse tells me write a verbal order from the doctor that it was OK to draw blood from her foot x 1 (on the non-DVT leg of course). I asked other nurses why this was--they said drawing blood from the foot can increase the risk of DVT? I figured the lab results might be less accurate from the feet but I hadn't considered DVT. Should it be worrisome that she already had a DVT in the other leg? Does anyone know why drawing blood from the foot is a last resort? (The patient is getting a PICC line because she's such a difficult stick!) Thanks!
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  3. 4 Comments so far...

  4. 0
    It is for the reason you were told. We have to get a doctor's order for any form of venipuncture in the feet -- be it blood draws or IV siting.
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    Also, anyone with bad circulation or delayed healing would have a much greater risk of infection setting in.
    Ex. diabetic
    turnforthenurseRN and psu_213 like this.
  6. 0
    Quote from NurseOnAMotorcycle
    Also, anyone with bad circulation or delayed healing would have a much greater risk of infection setting in.
    Ex. diabetic
    Exactly this, so make sure you transcribe that verbal/telephone order.

    Also, if the patient is getting frequent blood draws and they are a hard stick, why not advocate for a central line or PICC line?
  7. 0
    Quote from turnforthenurseRN
    Exactly this, so make sure you transcribe that verbal/telephone order.

    Also, if the patient is getting frequent blood draws and they are a hard stick, why not advocate for a central line or PICC line?
    The OP said the patient IS getting a PICC line since she is a hard stick.


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