Foot IVs

[piccrn56]

Hi! I'm hoping that some one has data on why foot IVs just should not be placed. In my large city hospital it has become common for IVs to be placed in feet. We have been encouraging that if a pt has a foot IV the nurses should generate a referral to the a PICC team. This seems to be very upsetting to the anesthesia staff as they would rather place an IV in a foot than start a CVC. They of course want to see data supporting why fooot IVs are BAD!! Please help!!

[prmenrs, RN]

One word: thrombophlebitis. We do it all the time in neonates, but I'd worry about adults, esp those w/peripheral vascular disease or edema of any sort.

This may not be evidenced based practice, but it seems logical to me.

[iluvivt, BSN, RN]

There is all kind of evidence suggesting that this practice be avoided. It is OK in emergency situations but once the crisis is over a more suitable line should be placed. There are deep venous sinuses in the legs this increases the chance of thrombosis and embolism. Where do we see a lot of DVT's...in the calves...do we really want to administer irritating drugs through these vessels.....Also many people have varicosed veins in their lower extremities and there can be drug trapping B/C of this....and this means delayed drug effect also check the INS guidelines...and ask the question on ivtherapy.net. I agree with you a PICC is far better than a foot IV in most situations . Find out why the MDs do not want them...perhaps they need to educated..the fear may be infection risk....explain to them it is very low...usually 1-2% TELL THEM WHY CAN i HELP YOU IN ANY OTHER WAY MARY

[iluvivt, BSN, RN]

I forgot ,,it is acceptable to use the lower extremities in infants. Once they are up and walking try to avoid it. will also review my literature to see if i forot to include anything in my response

[UM Review RN, ASN, RN]

Recently had a patient who insisted on having IVs placed only in the feet. Actually, the right foot. I couldn't believe they gave in to that demand as the patient was getting a lot of antibiotics.

Why didn't they place an IJ? It's done all the time when emergency access is needed.

[piccrn56]

Thanks to all of you for your help. I spoke to one of our Anesthesiologists who is quoting data from 1965. They are convinced that foot IVs have less complications than CVC, including IJ with US guidance. We agree that they should be short term but I am thinking hours not a day or two. We all know that common sense doesn't always impress the medical community. We still have to meet with Anesthesia about this issue. We plan to show them pictures of foot IVs that have caused infiltration and the resultant complications. If all else fails I would like to ask how they would feel about a foot IV in their mother, wife, or loved one.:innerconf

On a positive note I have a meeting with the Chief Mecical Officer about the future of the PICC team. My goal is to place the appropriate vascular access device in every patient within 24-48 hours of admission. :w00t:We also plan to petition the State Board in PA for Nurses to perform EJ line placement. Any ideas or suggestions to how to best go about this????

Thanks, again Karen:redbeathe