Drawing Blood

[fat cat]

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 blood. When I questioned that nurse about it she said that it was no problem - that she just got it from the patient's foot. As a nurse I have drawn blood for many years but never considered using the foot. I asked the nurse if she got a doctor's order for that and she said no that one was not needed. I want to know if any other nurses out there draw blood from the foot as a last resort.

[EmmaG, RN]

Never needed an order in the ER, but I've never seen any other unit that allowed it without an order. I've started many an IV in the foot and ankle too. If I was called to the floor to assist with a hard stick I always got an order unless I knew the doc would back me up with one later, but in the ER no order was needed.

But was there a policy/protocol that allowed you to do so? I've never worked ER btw.

[VandyNurse714]

I work in an ICU, and we use feet all the time for IVs as well as for peripheral sticks. We never need an MD order. We do not, however, stick a patient with diabetes, for obvious reasons. I've started an IV in my own foot before (practice, no one else would let me), and it really wasn't that painful.

If the nurses are having that much trouble with access, even after trying for the feet, we speak to the MDs about the possibility of a central line. But, like I said before, I work in an ICU.

[Preemienurse23]

I work in the NICU and the feet/legs are used just as much as the hands/arms are for IV's and if there is nowhere else for cultures (such as the scalp), but for labs, I have seen some of the veins in the foot used.

[RNcDreams]

We are supposed to get an order from an MD... can't say for sure how many people actually do.... i was told this is risky because the lower extremities are more prone to pooling of blood, thus increasing the risk of clot formation with venipuncture.

But... if it's your only option, ya gotta go there.

[cmo421]

ICu,ER,Trauma,,,,feet r used all the time. One can be drawing from the feet as others are working above. Of course if limb is compromised in any way,this should not be done. If in the ICU or on the floors, a foot is needed to draw,for the pt's comfort and safety,it is time for a pic or central line.

[purple1953reading]

I too have used the feet esp in ICU, when everything is shot, and never needed an order, but would avoid the obvious, NONE in the diabetic. I actually had to start on on the breast so to speak one day. The lady came in covered in yeast, red, weeping, smelly yeast under every skin fold of her 300 pound plus body on her 4ft. frame. THe drs. did not want to do a central stick, till the yeast was under control, afraid of yeast systemically. She had these huge beautiful veins across the top of her breast/chest, and I asked her if she could hold still, and when it was over she said WHEN are you going to do it? It lasted long enough that IV meds helped to the point they could move on. It was scary but very easy.

[quijarz]

i did it once and I can still remember my patient's face was in agony, it was very painful.I felt guilty and made a promise not to do it again unless in critical situation

[jmgrn65, RN]

As a former phlebotomist, I would NOT use a foot without a physician order. I would be more inclined to draw the patient from the radial artery(Granted a little trickier) but I can do that without an MD order.

How in the world can you access an artery without a Doctors order, that is way more dangerous than the foot.

[UM Review RN, ASN, RN]

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.

[pagandeva2000, LPN]

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.

[Foot blood draws]

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.

[PICNICRN, BSN, RN]

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!