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Foot and ankle venipuncture is generally discouraged in adults because of increased risks of thrombosis, infection, and impaired circulation—especially in patients with diabetes, peripheral vascular disease, or edema. Many facilities require written provider authorization before using these sites, and some prohibit them entirely except in exceptional circumstances. By contrast, antecubital veins (median cubital first, cephalic second) and dorsal hand veins are standard options that balance accessibility with safety. The basilic vein is often a last resort due to proximity to the brachial artery and median nerve, but still preferred over the foot in most policies. When upper-extremity access is not feasible (e.g., bilateral mastectomies, extensive edema, or IVs), phlebotomists should escalate: consult nursing, seek provider guidance, consider pausing IVs and drawing below an infusion site, or use alternative devices such as a winged set in a dorsal hand vein. Proper documentation of site selection, clinical constraints, and any provider authorization is essential. Understanding institutional restrictions and anatomical risks ensures safer practice, reduces adverse events, and aligns with certification expectations around patient safety and site prioritization.