PIV access in foot contraindicated?

[VentdependenT]

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Is this absolute or relative (yeah I know if the patient is bleeding out/unstable access is access)?

I wanted to place one in a patient who was anticoagulated (hep 5000 subQ bid) who needed iv abx but had unsuitable UE veins. However the nurses completely shot down my idea. Even though I have seen plenty of PIV's placed in that area I didn't push it.

I realize that PIV's in lower extremity can cause superficial thrombophlebitis which can lead to a hypercoaguable state causing clots which may extend to deeper veins in the leg, or possibly the contralateral leg. I'm curious as to how common this is, especially in someone who is on heparin/anticoagulated?

Drop me some of your thoughts y'all.

 

[UTSouthwestern]

The situation you described has absolutely no contraindications, absolute or relative. DVT prophylaxis with minidose heparin does not even contraindicate a central line, much less a peripheral IV.

An argument can be made for the feet being less than sterile, but then again, you will be cleaning the area to be accessed before placing the IV and in any case, it is not the nurses call.

Superficial thrombophlebitis can occur in any superficial vein and I would offer a case in point, a call I received one night from the Parkland SICU asking for peripheral access in a patient with bilateral upper extremity thrombophlebitis. Put a 16 gauge in the left saphenous vein and it lasted for an entire week at which time, her upper extremity thrombophlebitis resolved and the nurses were able to find a suitable upper extremity site for access. I could have easily gone one step further and placed a central line or PICC line, but that would have unnecessarily introduced an entirely new set of possible complications onto patient already in a precarious situation.