I am not sure what you are needing to show to them - pro or con. Veins of the lower extremity in an adult have much higher rates of complications and therefore the national standard for many years has been to avoid them. A complication in the foot will lead to serious problems because of the higher number of perforating veins - veins that connect the superficial with the deep veins. So a phlebitis can become a DVT quickly. Blood transfusions that leak from the vein and enter the subcutaneous tissue are classified as extravasation and have the highest rank on the grading scale used by the INS standards of practice. Finally difficult venous access can be a problem in many patients these days, however there are ways to avoid using the lower extremities. The use of ultrasound to locate veins is available and the use of infrared light devices is growing, although not widely available at the present time. I would also ask what other therapies this patient is receiving, the pH and osmolarities of those therapies, and the anticipated length of therapy. There is probably an indication for a PICC or some other CVC that will ensure that all therapy can be infused through a single device, rather than multiple peripheral sticks. All this adds up to the use of veins in the lower extremities should only be done in a severe emergency when access is needed quickly and there are absolutely no other alternatives. I have been practicing infusion nursing since 1972 and have never seen the time when I found it necessary to infuse blood through a vein of the lower extremity.
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
Thank you so much Lynn. I was looking for the con - because anesthesia is using the tactic "I wrote the order, so you do it" and I have been advising otherwise but did not have a reference. Are you aware of anything published that supports the position. What I have found is generally light reading and nothing scientific. Thank you for your assistance.
That approach from any physician should never work with any nurse. I can not direct you to a single article that addresses this question directly. The A&P info, the classification of blood as an extravasation, the need for proper vascular access assessment, etc, all comes from different locations and is all part of the knowledge and skills that come with an infusion nurse specialist.