It is possible to receive an intravenous (IV) line in your leg, though it is not the preferred location for adults. A peripheral intravenous (PIV) line is a short catheter inserted into a small vein, typically used for administering fluids, medications, and blood products directly into the bloodstream. Healthcare professionals strongly favor upper extremities, such as the hand and forearm, because they are associated with fewer complications and generally offer better vein access. Using a lower extremity for a PIV is a medically acceptable practice when necessary, but it is considered a site of last resort in most adult care settings.
When Lower Extremity IVs Are Necessary
The decision to place an IV in a lower extremity is made when all viable upper body access points are unavailable or compromised. This situation often arises when a patient’s upper limbs have extensive burns or trauma, making those sites unusable for cannulation. Repeated venipuncture from chronic illness or frequent medical treatment can also deplete accessible veins in the arms, forcing the care team to look elsewhere for vascular access.
Severe swelling, known as edema, in the upper extremities can also obscure veins and make successful insertion extremely difficult. In these cases, the veins in the lower body may remain more visible or palpable. Patients with a history of intravenous drug use may have sclerosed or damaged veins in their arms, which necessitates the use of alternative sites like the leg.
The lower extremity may also be chosen to preserve upper body veins for future procedures, such as creating an arteriovenous fistula for dialysis access. A lower extremity PIV can be a temporary, life-saving measure in emergency situations when immediate access is paramount. In these critical moments, the medical team prioritizes establishing flow over the potential for long-term complications.
Specific Vein Placement Sites
While the term “leg IV” is used broadly, the insertion site for a peripheral line is most commonly located in the foot or ankle region. The veins in these areas are more accessible and less prone to movement than those higher up the leg, which helps reduce the risk of the catheter dislodging.
One of the most frequently targeted veins is the Dorsal Venous Arch, which is a network of superficial veins across the top of the foot. The Metatarsal veins, which feed into this arch, are often utilized for their accessibility. Another common site is the Great Saphenous Vein, particularly the portion near the ankle, just anterior to the medial malleolus.
These veins are chosen because they are generally large enough to accommodate a standard IV catheter and are relatively easy to stabilize. However, the skin is thinner over the foot and ankle bones, and the veins are often surrounded by more delicate structures. This anatomical reality contributes to the increased risk of certain complications compared to the more muscular and padded forearm.
Increased Risks Associated With Leg IVs
The primary reason lower extremity IVs are avoided in adults is the significantly increased risk of developing serious vascular complications. Unlike the arms, the veins in the legs must work against gravity to return blood to the heart, which slows blood flow and increases the chance of blood pooling. This sluggish circulation creates a higher risk environment for clot formation.
A major concern is Deep Vein Thrombosis (DVT), which is the formation of a blood clot within a deep vein, often in the calf or thigh. While a PIV is typically placed in a superficial vein, the presence of a foreign object in the lower extremity’s venous system is associated with a higher likelihood of DVT compared to upper extremity placement. If a DVT forms, the clot can potentially break loose and travel to the lungs, causing a life-threatening pulmonary embolism.
Lower extremity IVs also have a higher incidence of thrombophlebitis. The rate of phlebitis is reportedly higher in the lower limbs, due in part to the effects of gravity and pressure on the catheter site from walking or standing. This localized inflammation causes pain, redness, and swelling, and often requires the immediate removal of the IV line. The lower limbs also carry an increased risk of infection because they are closer to areas with higher skin flora and are more difficult to keep immobilized and clean.