Can We Start IVs in the Foot?

Can We Start IVs in the Foot?

A question commonly arises about whether or not we are able to start IVs in a patient’s foot.  We have received guidance from our OMD, Dr. Stewart Martin, and want to share it with you.

IVs in the foot/lower extremity are supposed to be rare.  It is highly unusual to start an IV in the patient’s foot and should be avoided due to a high infection rate, potentially increased venous pressures, and the fact that a peripheral IV in the foot is much farther from the central circulation than an IV in the upper extremity or external jugular vein.  Also, the presence of varicose veins or generally poor lower extremity circulation will lead to complications with IVs in the feet.

When might it be appropriate to start an IV in the foot?

  • Adult
    • When you have been unable to establish an IV in the upper extremity or external jugular vein and you need access to administer a medication and intraosseous would be inappropriate.
      • For example, if you have a hypoglycemic patient and are unable to establish an IV in the upper extremity or external jugular vein, you would administer Glucagon IN/IM; if the Glucagon isn’t working, you would still have a need for D50, but it would be inappropriate to start an IO on a hypoglycemic patient who is not in extremis, so you might consider an IV in the foot for administration of D50.
    • If your patient is not in extremis with an immediate need for medications or fluids, an IO is obviously not appropriate and neither is establishing vascular access in the lower extremity – this patient can wait to have vascular access established at the hospital.
  • Pediatric
    • Pediatric patients do not commonly require pre-hospital vascular access.
    • If your pediatric patient requires pre-hospital vascular access for medication and/or fluid administration, you should first look in the patient’s upper extremities. If you are unable to locate a suitable site or establish vascular access in an upper extremity, you may start an IV in the pediatric patient’s lower extremities, especially if the patient is non-ambulatory.
    • You do not have to make unsuccessful attempts to establish access in an upper extremity before you look for a suitable site in the lower extremities.
  • Patients in extremis or cardiac arrest
    • For patients in extremis or cardiac arrest, IVs in the feet are not appropriate. You should establish IO access if you are unable to successfully establish an IV in the upper extremities or external jugular veins.

Utilize this guidance along with sound clinical decision-making to determine the best method and location for establishing vascular access.

For questions, please contact Capt. Jerry Sourbeer.