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Archive for August 8th, 2011

I’d been planning to write a blog post on this topic for a while as it has become a major concern for me over time, especially since starting Orencia infusions in June.  Then a converstion on twitter yesterday confirmed that it is something that an increasing number of us have to think about, now that so many of the treatments prescribed for Still’s Disease (and similar conditions) are Intravenous, meaning that they are administered through a vein.

Intravenous drugs you may have heard of in Still’s treatment include:

  • MabThera (Rituximab)
  • Remicade (Infliximab)
  • Orencia (Abatacept)
  • RoActemra (Tocilzumab)
  • IV Ig Immunoglobulin Therapy

Over the past fifteen years I have had countless IVs – Two years of Immunoglobulin therapy (3 days a month), Blood transfusions, Heparin, Saline fluid replacement, IV Steroids, Antibiotics and Anti-Histamines, General Anaesthesia… basically, multiple hospital stays that required intravenous access for one reason or another.  Add to that, the fact that most of the medication I have been on throughout this time has required either fortnightly or monthly blood monitoring, and you can see it has been pretty tough on my veins.

And I know this has been the case for others too.

At some point, I realised that it was getting harder for them to find a good vein; in fact, I was left with only two ‘good’ ones in the crux of my right elbow.  When things were spaced apart it wasn’t too bad, they could usually recover enough between blood tests to be usable again, but multiple blood tests and cannulation during hospital stays became a nightmare.  One particularly worrying experience happened when I went down to theatre for my last surgery and even the anaesthetist couldn’t get a cannula in.  He ended up knocking me out with gas instead and I woke from the surgery with a cannula near my clavicle, which wasn’t too bad that time but I wouldn’t want to be awake for them to try it!

Since then, I’ve had doctors and nurses try all sorts of strange places to draw blood or insert an IV; from thumbs and wrists, to palms and forearms, usually taking numerous attempts before finding success.  Every hospital stay it becomes an issue and I am filled with dread – I can deal with most prods, pokes and pains, but for some reason the thought of them having to cannulate anywhere but my arms fills me with fear.

And now, with only one working vein, the Orencia infusions are becoming a worry to me because each time so far there has been resistance in the line and we’ve struggled getting the infusion through. What will happen if this one gives up also? I dread to think, but there are certain things that we all can try to improve our chances of providing a good vein frst time:

Tips to Boost Veins for Blood Tests and IV Cannulation

  • Stay hydrated – make sure you drink plenty of fluids before you are due to have your infusion or blood test to pump up those veins. Start this at least a few days beforehand if you can and limit the amount of caffiene you drink too, as this only dehydrates veins.
  • Stay warm – if you are cold, your veins will constrict and be much more difficult to find.  I’ve even known nurses to advise placing a hot compress on the area to be cannulated to dilate veins.
  • Rotate sites if possible to give veins chance to recover, keep track of which vein is used and when.
  • Advise the nurse / doctor if you know a certain site is not productive, rather than let them try and be unsuccessful. You know your body better than anyone and it will save you some bruises.
  • Ask for a phlebotomy nurse when possible, as they have much more experience in finding difficult, deep veins that others might miss. They do it all day every day after all!
  • Ask them to use the smallest needle they can; although this will depend upon what is being infused.
  • Relax and make sure you are comfortable; don’t look at the needle, it may be an ‘old nurses’ tale but some say that veins retract when a patient watches, even if you think it doesn’t bother you.
  • I’ve read that hand strengthening exercises can boost veins in the arms; I’m not sure how much truth there is in this one but I’m going to buy one of those stress balls to squeeze just in case!
  • Also, doing some simple stretches / arm exercises prior to cannulation can help get the blood flowing and warm up the limb, although with painful joints this is not always possible.
  • Finally, dangling your arm over the edge of the bed/chair for ten minutes beforehand will allow gravity to increase blood flow to the limb.

I know that these tips won’t work for everyone but they’re certainly worth a try; I will definitely be giving some of them a go to conserve my remaining vein, maybe I’ll even find a couple that have been hiding.  If anyone else has any advice please let me know and I’ll add it to the list.

I’ll keep you posted if I notice any improvement,

L

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