 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.Â
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.Â
Thanks in advance and Happy Healthy Holidays to each of you.Â
Nancy DuBois, CRNI, MSN
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
www.hadawayassociates.com
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
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