How to get a foot draw?

Moogie, I'll bet you your insurance company won't have a clue either. My lab also tells me that they don't do foot draws when I call them, but if I show up with the blood test order in hand and the doctor has written "Draw from foot only!" on the order sheet, by golly if they don't get their best phlebotomist and just do it. Others here have had the same experience, so it might be worth a try. They WILL NOT do it unless that's written on the sheet, though. Nobody will.

It helps to be really well hydrated, warm your foot right up until they're ready to draw (I use a microwavable heating pad -- have to be careful not to get it too hot), and ask to lie down for the draw (because it's MUCH easier for them if you're lying down so they don't have to squat on the floor to reach your foot and they can lay out their supplies right there -- they don't think of that, though, unless you tell them.) Some women who have gotten objections say, "What would you do if I didn't HAVE arms?" Apparently that helps jog their thinking along the lines of problem-solving for our situation.

Let us know how it goes!
Binney

What about getting a port and avoiding the foot draw thing altogether????

So it would be best for my MRI to have the IV contrast done in my foot?? Does it hurt more? My bs told me that it is hard to have the IV in the foot because of all the valves in the leg. I am having an MRI on Thurs and would rather not have my arm subjected to another blood draw or IV. I am getting my port in again this month.

I work in a lab at a Cancer Center.  The reason your labs do not draw from feet is that it is dangerous for ambulatory patients to have their feet drawn and then walk out ...there could be issues with clots etc.  That is why they do not do it. It is not that the personal are not capable.   The other issue is that the latest information out from the Breast conference says that patients CAN be drawn in their arms after a masectomy.  Our physicians allow this ...we try to draw from the side with the oldest surgery.  We go without tourniquets if possible etc.  There are still surgeons in our area that impress on their patients not to have draws from their arms..  When they do it puts us in a rough spot. 

Hope this clarifies something for somene.

Diane and Leesag,

  There are no studies that support the use of an at risk arm for blood draws: what Breast Conference are you referring to--the San Antonio, ASCO?

Also, any reference that  proves that a foot draw of a superficial vein causes DVT's in ambulatory patients would be appreciated.

There is a movement to "debunk" lymphedema risk reductions, and this issue of using the at risk arm or an arm with lymphedema has no science, that I'm aware of, to support it.

  But it sure is easier for the phlebotomist--

  Diane has lymphedema on one side, and an ALND on the other--so technically both arms are off limits for blood draws, blood pressures, IV's.

  There are a few women on this forum who have bilateral LE, and they have found physicians and centers that draw blood from their feet, take calf blood pressures and use foot IV's for studes and procedures.

  The official position of the National Lymphedema Network would be to avoid any trauma to either the arm with lymphedema or the arm with 18 nodes removed. The last thing Diane needs is another arm with lymphedema.

  The surgeons who advocate for their patients and request that you not traumatize their at risk arms may put you in a tough spot, but they are following national concensus guideliines.

  I have lymphedema in one arm, and recently my "good" arm was used for IV contrast for an MRI: 3 sticks later, and huge bruising, the arm and hand were bruised and sore for almost two weeks. If that happened on an arm that had 18 nodes removed, it could have triggered permanent swelling.

  For your future reference, here is a link to the position paper of the NLN on risk reduction guidelines:

http://www.lymphnet.org/lymphedemaFAQs/positionPapers.htm

Additionally, here is the handout on lymphedema from the Livesstrong Foundation, written by national researcher Jane Armer PhD, who had an ALND and was told not to worry about lymphedema, and developed it within 6 months and has devoted her career to helping other women treat and avoid lymphedema:

http://www.livestrong.org/Get-Help/Learn-About-Cancer/Cancer-Support-Topics/Physical-Effects-of-Cancer/Lymphedema

Diane, in NYC, there is a great lymphedema researcher, Mei Fu PhD at NYU, she is doing a study on women with lymphedema and prevention and can assist you in this issue:

Mei R. Fu, PhD, RN, ACNS-BC
Assistant Professor
Course Coordinator
Fundamentals of Nursing
College of Nursing
New York University
726 Broadway 10th floor
NY, NY  10003
mf67@nyu.edu

Sorry to be so strident about this, but the movement to "debunk" lymphedema risk reduction behaviors is so prevelant, and lymphedema is a chronic, incurable condition, that I get really upset when women are told that it's been proven that precautions are unecessary. Caution is necessary to prevent a chronic disease. I'm sure many women have "gotten away with it"--but what about even the one in which it triggers lymphedema? Isn't it better to err on the side of caution and not give women advice unless you have the study that PROVES that it's perfectly safe--over many years?

Kira

Just realized that the earlier post was in May, and she's not likely to check back in, but I sure hope she does.

I just checked and that was the only post she ever made.

Hi everyone,

Thanks for the information that I received. I feel that there has to be someone that will take blood from my foot. Kara, I will follow-up with all the information you provided and I will contact the lymphedema researcher.Also, the message from OneBadBoob gave me encouragement. I am new to this message board and I have spent several hours just locating the messages. I guess I will improve. My good computer is being fixed and now I am using an old one that is very, very,,,,,slow.I will keep in touch, thanks again.....diane

After running into problems with permission/approval for foot blood draws in April, I gave in and let them take blood out of my hand on the side with prophylactic mast and no nodes.  This time around, I thought I had everything in order, but oncology department still insisted I go to the hospital lab to have this done.  All phlebotomists rotate at this facility, so it's the same staff that sometimes works at the hospital and sometimes at the cancer center and can't be an issue with training.  At the hospital lab the tech wasn't the least intimidated and although never having done a foot draw, handled the job efficiently and with no problems.  She had to raise the height of a computer stool for me to put my foot on since a table was not available. 

Later, my onc told me that foot draws are more susceptible to infection and that's why they are not recommended.  She also indicated that having had just a prophylactic, no node mastectomy, I needn't worry about lymphedema.  She didn't come right out and say that exactly, but hinted at it very strongly.  She gave permission regardless. 

On my way out, I stopped in at the cancer center lab and asked to speak with a supervisor as to why I couldn't get foot blood draws done there.  The phlebotomists said they had always been instructed it was because of blood clots.  After discussing it with the supervisor, I was assured that my onc would be contacted and orders would be placed in my chart for all future blood draws to be done on my foot at the cancer center lab.  Success, but what an ordeal.  

Can anyone tell me what reason there could be for more risk of infection in the foot than in the hand?  Even if there is an increased risk, which I can't understand, it still seems better to me than the risk of lymphedema!

Paula, I too had snb on both sides (3 on one and 4 on the other) and don't like blood draws from my arms, I have developed slight LE in the proph side (4 node side) in my hand. as far as the blood pressure in the leg, I purchased a home bp cuff and have practiced taking it on myself. I use the calf instead of the thigh and it is much more comfortable. I take my personal bp cuff to the doctor's office and teach the nurses how to take it on my leg. I will try to find the thread where we discussed bp in the leg and 'bump' it to the top, there was a good picture that was posted about where to find the pulse in the ankle.

edit - found it 'Recommendation on BP cuffs' - picture is about half way down the first page. I copied and pasted the picture in a word document and have it with my bp cuff as well as the instructions printed out on how to take a leg/ankle bp.

Sheila 

Paula, I just bumped the recommendation for bp cuffs back to the top of the LE board. If you go to the LE forum and scroll down the list of topics it will be one of the first ones below the 'pinned' topics.  I still have to fight to get foot draws for any blood work. The doctor's office couldn't get a vein and sent me to the hospital and they didn't even try, they said that they could get it on my arm without a tourniquet but I still objected.

Sheila 

I am a newbie to the board but wanted to chime in to say many test facilities (MRI, PET-Scan) will refuse to utilize a port for contrast.  I have a port and still need to have the contrast inserted through an IV even though both arms are compromised with existing LE. This has been my experience at three different large radiology providers.  I have gotten to the point with requests for blood pressure readings (since it is always normal result anyway) to point blank refuse them.