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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7 Answers

Using the ankle and foot for venipuncture and IV therapy is to be discouraged because it is a weird thing to do, the feet are relatively thick skinned (deeper epidermis to clean and puncture) and the ankles and feet are hardly as clean as our arms, wrists and hands. So yes, perhaps infection is more likely, especially in the relatively poorly vascularized (diabetic and PVD). So use those swabs and give them lots of time to work. I use betadine followed by alcohol if I must go there. There is no evidence for any of these concerns, the betadine/alcohol makes me feel better.

However, it is simply an urban myth to suggest drawing blood from an ankle or foot increases the risk of DVT. I heard this yesterday at the hospital, it didn't make any sense to me and I've just searched it now: NO evidence for this claim. I did find: Phlebotomy Tools of the Trade: Part 3: Alternative Sites for... : Home Healthcare Now

But can't read on after the first page with this link. I suspect there are claims to "beware", but there is not evidence to support this belief, nor any rational I can understand or believe. That said, if it makes you feel better, I'd be happy to give you an order for it. Then I'd learn our poor patient is not easy to get blood from and I'd have the opportunity to remind you to use extra precautions sterilizing the site.

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.

Specializes in Med-Surg, Emergency, CEN.

Also, anyone with bad circulation or delayed healing would have a much greater risk of infection setting in.

Ex. diabetic

Specializes in ER, progressive care.
NurseOnAMotorcycle said:
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?

Another consideration is pain; feet are very sensitive! I had to have bunions and bone spurs drilled off my feet as a teenager (ex-ballet student) and when the lidocaine needle first went in, the anesthetist had to hold me down and crank up the gas--it hurt like a mother.

Welp, I'll bite on what looks like a revived topic...

Dr. Kennedy said:
and the ankles and feet are hardly as clean as our arms, wrists and hands.

I find that extremely difficult to believe. A quick search didn't immediately turn up evidence of such, but I'm willing to learn....

We all know 'your phone is dirtier than a toilet'...but our feet are dirtier than our hands?? Are you sure?

Also..."it's a weird thing to do"? So is a Harris flush (and a lot of other things we rarely might try under certain circumstances, if you really think about it)...but sometimes it's necessary. We're not talking about someone with poor IV skills just poking anything (I hope) but rather experienced and skilled venipuncturists deciding there are currently no other options.

turnforthenurseRN said:
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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