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Nancy L. DuBois
peripheral IV site placement in the lower extremities in adults

 I work in a tertiary care academic medical center where the anesthesia MD's are more commonly placing IV's in the lower extremities of adult patients when they encounter difficulty in establishing a patent site in the upper extremities. The nursing staff in the PACU are telling the doctors to find alternate venous access which is causing  the MD's to  "revolt" stating that there is no evidence that states that lower extremity IV's are not safe!!  In fact, the MD's are telling each other that using the lower extremities for venous access is SAFER than placing a central line. 

I have gone to the INS Standards of Practice, of course, but would like to know if any of you have other evidence based research articles that will "calm the stormy waters" in the anesthesia dept. 

Thanks in advance and Happy Healthy Holidays to each of you. 


Nancy DuBois, CRNI, MSN

This is based in Human

This is based in Human Anatomy 101 - there are more perforating veins in the lower extremities. These are veins that connect the deep veins to the superficial veins. Therefore a simple phlebitis in a superficial foot vein has a great chance to become a deep vein thrombosis. Second, this is common sense that most adults will be ambulating ASAP after surgery. This can not happen with an IV in their foot. Third, this has been a national standard for so long (at least 30 years that I can remember) even if you did find the old studies, these docs would say the evidence was far too old to use. So if they insist on placing them in the foot, and the IV therapy must continue past the PACU, then it must be up to the nursing staff to get them out of that foot ASAP. You might not be able to change their mind, but the care of the patient after the OR is up to the primary care nurses. So you would be the one bearing the responsiblity for leaving it in that site.  


Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Gwen Irwin
Our facility requires a

Our facility requires a physician order to even place an IV in the foot.  This is based on the increased risk for DVT.  If  an order is obtained, then it is always the best option to get it out of the lower extremity asap and get an appropriate line in place.

Gwen Irwin

Austin, Texas

Leigh Ann Bowegeddes
Also, an MD order to put an
Also, an MD order to put an IV in the foot doesn't protect you or your patient from the potential negative outcomes, and seems like an unreasonable thing to include in policy. If a nurse is going to put an IV in the foot, it should be based upon that nurse's critical judgment, not a verbal order from an MD. The MD is not there assessing the patient. I personally have NEVER put an IV in the foot of an adult. The last time a doctor at the bedside told me to put an IV in a patient's foot (because we couldn't get UE access), I said, "YOU put an IV in his foot. I'm not going to do it." She had a change of heart about the wisdom of this, and put in a central line.
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