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.

[Spidey's mom, ADN, 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!

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

[ChristineN, 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!

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.

[queenjean]

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]

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.