HI, all,
I have a question regarding the cut-off age for placing PIVS in the lower extremities, particularly in older children. There is a an old [landmark] article that says children approach adult phlebitis rates when they are 10years old. Our current policy is to avoid lower extremities in kids > 10 years unless they have no other sites [ie. a pt. whose arms are burnt, for example]. Occasionally, docs or patients request foot and leg veins in older kids and we usually say no, but we had a child the other day who was an older teenager with spina bifida who had no feeling in her feet. She wanted the IV in her foot and the IV was only for short term use for MRI contrast. Our recommendation was to use LMX cream to numb and upper extremity and place the IV in an upper limb. We have seen some complications from foot IVs such as DVT, infection, phlebitis, and even a PE, in older immobile kids who had leg/foot IVs for longer term. Does anyone have an update [opinion or evidence based info all welcome!]
Thanks,
Anne Marie Frey
The Children's Hospital of Philadelphia
I have not seen any more recent publications than what you already have. My opinion would be that your internal data and experience is the best evidence available. I think you approach would be best - to avoid the lower extremity in any ambulating child and/or immobile older children for just the reasons you mentioned. I don't think MRI contrast would be injected under high pressure, but could be wrong on that. If it is I would be extremely hesitant to use the lower extremity of any body. I have seen too many lawsuits involving high pressure injection injuries from infiltration. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
so many times that kids with spina bifida insist having PIVs in legs because they can not feel there.
explained many times to them & families that one of the clues for PIV complication is pain.
some agree with UE PIVs. some still go for the LE's.
one case of LE DVT required long term LMWH.
it is hard to know the true incidence of LE PIV related DVT if they are not done routinely or done when other options are exhausted.
when ICU bedrest kids got PIVs in LEs, staffs have been very good in calling us to place PICCs or PIVs in UEs with ultrasound