Alternative sites for peripheral IV access

[MacDSlim]

Hello, everyone!

I was hoping to get your opinions, experiences, and any known dangers or contraindications to gaining IV access in not so common spots.

Namely legs, feet, and chest wall (axillary vein).

In my experience, if they can't find a suitable vein or fail on the arm/hand they move on to EJ/central. I can't seem to wrap my head around why. No one really has any solid reasons as to the avoidance of alternative sites.

[Queen Maeve]

You are quite right. I am not asking for him to perform it without IV access, I am asking him to place the IV in a place other than in one of my arms or hands. Phobias are strange things, they are psychological pain rather than physical pain. If they could place the IV in my foot and I could cover it with a sock and I could not see it or feel it every time I moved or used my arms, I am pretty sure I could suppress the phobia. I am certainly willing to try. The anesthesiologist I met today flatly refused to even discuss this or any other option. He was arrogant, condescending, rude and belittling, one of those doctors who thinks he is God and cannot tolerate confrontation from patients, and he actually walked out of the room in the middle of the discussion. in fact I disliked him so much that I am going to ask for a different anesthesiologist.

[applewhitern, BSN, RN]

We aren't allowed to use the feet without an MD order, ESPECIALLY if the patient is diabetic. We do use upper arms, axilliary, and breast veins often.

[AnnieOaklyRN, BSN, RN, EMT-P]

I'm in the ER, so if I can get the IV but it's in a weird spot, I go ahead. I notify the doc before using it. Usually if we hydrate for a couple hours there are alternative sites available. I've never done a peripheral IV in the trunk, but would in a crisis. I have done feet and fingers, and if an adult patient is well enough I'll tell them to call with any swelling, and splint it well.

Please don't put PIVs in the trunk, this is asking for a lawsuit if the IV infiltrates as it WILL go unnoticed for quite some time. I have seen people put it near breast tissue in women and I just shake my head before removing it!!! Stay away from the trunk! If they are that sick and you cannot get a PIV in the arms, or feet don't do it, tell the doc to do an IO or central line!

Annie

[AnnieOaklyRN, BSN, RN, EMT-P]

We aren't allowed to use the feet without an MD order, ESPECIALLY if the patient is diabetic. We do use upper arms, axilliary, and breast veins often.

As I told the other poster stay away from the truck, axilla, and really avoid the breast tissue. You will get sued if the IV infiltrates as it will go unnoticed for some time and you may cause the tissue to become necrotic! If you cause a women to loose breast tissue that is not good!

Annie

[Queen Maeve]

Yes, I realize you need an MD's order to use an alternative site. I am not diabetic, by the way. But I had a meeting several days before the surgery with the Pre-Op staff, the purpose of which was to discuss these issues, and we did discuss my phobia, and they would not discuss alternative sites even though I told them I would not be able to tolerate leaving the cannula in my arm after the surgery, they said that was up to the surgeon. I also met with the surgeon that day, and told him the same thing. He said he would discuss it with the anesthesiologist. The day of the surgery when I had the confrontation with the anesthesiologist, the surgeon was in his office not 20 feet away, and after we had our little conrontation he walked down the hall to talk to the surgeon behind closed doors, but when he returned with the head nurse and pre-op staff, he refused to let me speak to the surgeon or have a brief meeting with the staff for 10 minutes to discuss alternative sites, they just immediately said "you're discharged, go home, reschedule later and discuss this with the surgeon." The pre-op staff then denied all knowledge of the discussion we had had on this subject the week before. The problem was the anesthesiologist. He was arrogant, condescending, belittling, a narcissistic jerk who simply could not stand an assertive patient who did not do exactly what she was told according to standard procedures, and he wanted me out of there. I don't know what he told the surgeon privately, but I am pretty sure it was not an accurate summary of our actual conversation.

I have been researching this online all night, and there ARE options for people with phobias, people with PTSD, people with missing limbs, people with Parkinson's, people with dementia, people with serious mental illnesses. My father had dementia for 12 years and if they put an IV in his arm he would rip it out unless he was retrained, and they have laws about restraining dementia patients in my state. They had to put it behind his knee and then wrap his knee in a bandage. These options should have been discussed in my pre-op meeting before the surgery. It should not have been up to ME to research this, the staff should have been more aware of them. Due to my condition (cervical stenosis C4-C6 with bone spurs growing into the cervical nerves affecting right shoulder and arm, terrible pain) I have been taking 30mg of Valium every day for 5 weeks, my mental sharpness has not been at at it's usual level of outstanding peak performance lately. I needed THEM to come up with options. At this point I can't even drive due to the levels of Valium I take.

[Asdf]

Late to the party here but Valium for pain? Or anxiety? I’m just guessing that the reason they don’t want to put a IV in your foot or somewhere else (not in your hand/arm) is because those other sites have much higher risks for complications (DVT, infiltration, extravasation, phlebitis etc) and if you’re going to have surgery I believe they need AT LEAST 2 access sites. If you have one access in your foot and it infiltrated or something else in the middle of the surgery it would be a BIG problem. Also, how does one get to have a phobia of iv’s in their arms? Did you have a bad experience?