Surgery - IVs & BP....?

Dejaboo

I meet with a surgeon that will be removing my Gall Bladder in July. I was not thrilled with him...But he was recommended by many as a good surgeon. He is a general surgeon that also does breast cancer surgery...My PCP thought he might be more open to No IVs. etc. Well, He really wasnt. Also when I told him I had arm & trancal LE already ...He said "so you had a full Auxiliary Dissection?" Ugh! No I had 1 node removed....Do you tell your patients that they cant get LE if they dont have a full dissection ( I didn't say that- but should have). He agreed to the Foot IV...But acted like he was doing me a favor. He said it puts one at a slight risk for...?.....I cant remember what he called it- I think it started with a N? What is the risk?

He said he would have them try the Leg cuff but if it wasn't working they would use my arm...He also went on to say that new studies show that a BP cuff does not put you at risk AT ALL. I would like to see the Info on that to back his claim...Has anyone new info on this? I bet there is none. He said he recently went to a LE conference even... Ugh. I didn't argue with him...As I need to just get this done. Figuring The surgery is short 45 Min usually...And Hopefully they dont check ones BP every 5 minutes during surgery...Does anyone know how often they do check it?

Any tips for a foot IV? So I can make sure they do it as easily as possible...When I had one before for my Colonoscopy...They didnt know what to do & it was so painful...Many tries. They elevated my leg & foot before trying...Ugh...I assume that was wrong. How do you find a vein if its elevated.

SummerAngel

I had a foot IV and leg BP cuff during my mastectomy, and no one even questioned it. The leg cuff worked fine for me. Why would the doc think the leg cuff might not work? Did he say? I recently had an appointment at an NCI cancer center and they took my BP on my leg, also no problem. They just elevated my leg for a few minutes prior.

I, too, would like to see studies saying that a BP cuff is just fine when repeated BPs (as are needed for surgery) are listed as a no-no on my lymphedema specialist's handout.

The foot IV was tricky for my surgery, too. They did not elevate it but they warmed my feet and put a tourniquet on the ankle to help locate the veins. They ended up getting out one of their "favorite" needles that has been discontinued but they keep a stash for difficult cases, and between three nurses they managed to get it going on the fourth try. Not pleasant but they did everything they could to keep me from experiencing too much pain, and afterwards all three of them hugged me and apologized for the trouble! When I woke up from surgery I had an additional IV in the other foot just in case, they said that foot IVs tend to "go bad" more quickly and more often than hand IVs.

Binney4

Hi, Dejaboo,

Sorry to hear about the need for this surgery, but hoping it will go really smoothly. For foot IVs I insist that the anesthetist do it--lots more experience and skill, I've found. Also, a shot of lidocaine (I think that's what it was!) in the area really helps. For me, far from elevating the foot, they hang it over the side of the bed.

I have no idea what he told you the risk from foot IV is, but there is a heightened risk of blood clots, so if you're prone to them that's something to consider. An alternative IV site is the neck, BTW.

I find leg cuffs much more comfortable on my lower leg than on the thigh. If they use your arm emphasize that they do the BP by hand, NOT AN AUTOMATIC CUFF, which uses more pressure than necessary.

The problem with proposing a prospective study to see if using a BP cuff on the arm causes or exacerbates LE is that it would be unethical to purposely endanger someone. So the only studies they could possibly do would be retrospective and rely on whatever anyone happened to remember about BP usage. There is, though, a push among some to discredit LE prevention tips, so some of those articles may be what he's referring to. Their argument is that there's no proof those measures work, but there's no proof they don't either, for the reason I mentioned. The jury's still out, and in the meantime it really is your call.

Might the surgeon be willing to consult with your LE therapist?

Please keep us posted!

Gentle hugs,
Binney

Dejaboo

Thank you SummerAngel & Binney. I wish I could remember what he said the foot IV could cause...He mentioned blood clot risk separate...so it was something else...I have searched for what it might be & came up with nothing. I will request that the anesthetist do my IV & ask for Hand monitored BP. I wish I felt it was my call. Its been awhile since I have had to deal with a Dr that denies health stuff...It was nice not to have to hear the crap.

I dont have a LE Therapist

SpecialK

When you sign the consent make sure you note all of this so it is in writing - write it in the margin if you have to, sign it, and get the doc to sign it.  Otherwise they have no obligation to do this other than your verbal request.  Make sure you read the consent before you sign it.

Kicks

SpecialK made a good suggestion. Be sure you list any changes in the standard release form on it somewhere. Initial it and get appropriate medical personnel to initial it also AND get a copy of it to file away.

I've had 4 surgeries since LE (3 eye,1 wrist) and it was the anethesologist who did the IVs - not surgeon. With the 3 eye surgeries I wore my sleeve and glove but not with wrist as it was on LE side.

I have not needed to do leg BP or foot IV as no issues at all with non-surgery side. It is my understanding that a foot/leg IV can be painful to put in, so you might ask for EMLA cream to use before to numb or request numbing spray.

An idea that might help - take a 'permanent' marker and write on arms "NO BP/NO IV".

glennie19

Dejaboo:  You have gotten excellent advice here. I also recommend writing on your arm with marker:  NO IV's or BP's and adding your requests to the consent form and having it signed. I used to work in the O.R. and I have a favorite anesthologist, and he always starts his own IV's. He doesn't want the nurses starting them.  So I would definitely request that your anest. start your IV.  EMLA cream for numbing and hanging foot off the bed will help to get the veins in leg larger and easier to access for the IV.  Do you know any of the anest's at your hospital?  One that you had before, perhaps? If you have someone that you liked, you can request the same one. There is no guarantee that you will get him/her, but most places try to honor your request if possible. Be sure and mention you want him/her before you had that one before.

The only N word that I can think of is perhaps neuropathy?  or Nerve damage?  That is possible but pretty darn rare. Almost seemed like a scare tactic, him throwing that out there. Just my opinion.

That part about 'trying the leg cuff' irritates me. What would they do with someone who is a double arm amputee?  They would have to use the legs. And as to the "studies", heck they can't agree if flying sets off LE, but how many people have had their first LE flare after a flight?? Geeeeeez

Dejaboo

wierd...I posted here this morning & its not here.   Lets see what did I say...Thanks for the tips on getting my requests on the consent form.  How does the OR team usually take this addition to the form...Well?  Or do they get mad sometimes.

Glennie it wasnt Neuropathy...I would have remembered that word...I still have no idea what he was refering to though.   I have not had surgery at this hospital for 7 years...So probably dont know any current anesthesiologists.

cinnamonsmiles

I went in the ER for an appendicits surgery that was a disaster. I won't go into all the details but I will share this:

I was laying in and out waiting for surgery in the pre-op room. I heard my surgeon tell the staff that I didn't have LE that I said I had lymphedema even though there was documentation in my chart history that was easy to find (the surgeons boss found it right away when i complained about what he did). All staff knew I had LE and that it was worse in the right arm. I went into surgery with a foot IV and came out with an IV in my right arm. Not one single person at that hospital would explain what happened in surgery that required a right hand IV. I was referred to the surgeon who danced his way around it all. Unfortunately, once you go under the anesthesia, you have no control no matter what you have written on your arm, what kind of informational sleeve you have or even if staff is aware. BTW...the only record in ALL my surgical and hospital notes was one smart hospital floor nurse who documented the hand iv.

I know that all surgeons and staff aren't like that...but beware because if happened to me, it can happen to others.

Anonymous

Dej, so sorry for yet another arrogant person, taking liberties in a position of advantage. This brings back memories and is a REAL sore point with me. If it's at all possible, and within your law, you might consider recording your appts?

I would not believe that BP cuffs don't put your arm at risk. It did with mine, and to this day I still have a lump caused by it.

As for needle placement, one of my success stories for a procedure was I had a local anesthetic as well as warming my foot prior to canula placement which an anesthetist did. It went really smoothly. The total opposite for another procedure.

Cinn, really sorry about your surgery. That is awful. Im not sure how you guys fare in light of asking to have a support person with you, but I can tell you, for one of the procedures I had, I was allowed. It was just as well. I shudder to think what might have happened had my hubby not been there.

Dejaboo

Thank you Musical.

cinnamonsmiles- Im sorry to hear what happened to you during your appendix surgery. I do believe there are a few crappy Drs & surgeons that do not care at all. I do not like those that do not believe what we say

Dejaboo

so my surgery is tomorrow.

Would someone help me word what I need to add to the consent form.

Short & simple. I want to say no IVs on either arm. No BP on arms...If it must be done It can be done on my right arm Manually- NOT automated.

I feel like if I say that - they will just skip trying my calf & do my arm anyway....

Is what I have above good & clear enough? Thanks

ksusan

Then take a photo of the amended consent in the same frame as your arm with NO BP or IV written on it.

glennie19

Sounds good to me, Dejaboo. Have them sign it and give you a copy. Write on your arms too.  Best of luck tomorrow.

Dejaboo

sorry I am so behind...wanted to update. Surgery went pretty good. The team was all set for me with Stickers on my chart saying no IVs or BP in either arm. I was allowed to wear my sleeve & my compression bra. I added my instructions to the consent form. All went well until the OR pre room- whatever thats called. Anesthesiologist came in & so did his assistant. They really wouldnt agree on who would do my foot IV. A Nurse came in to do it...I had already asked for the Anesthesiologist to do it...But he wouldnt for some reason...Nurse tried & blew a vein & boy did it hurt! I thought at least its done...Then she said No, sorry it didnt work. So then the assistant came to help out...I did ask him to use Lidocaine...He said it makes it harder to get the IV in...And wouldnt use it. he also kept telling me 'thats why I dont like to do foot IVs' Over & over he said it about 20 times. I finally said Well I dont like living with Lymphedema!! Of course by then I was about to loose it & I did. They didnt even offer me a kleenex I had to ask for one!

Also the Anesthesiologist made the comment that for 'Those that want a foot IV' I dont know what he was leading up to saying...because I interupted him I said- 'I dont want a foot IV , I need to have it!'

My arm LE did get worse from surgery. Now a month later it is still bad...though I feel it has improved since the 1st week out. My Trancal LE got worse about 1 week after surgery & is still giving me problems.

SummerAngel

Oh I am so sorry! I'm so angry for you! When I had my BMX and they needed to do a foot IV the first nurse tried and failed in one spot, then called another nurse in. She tried another spot, then called a third nurse in. They got one of their "favorite" IV needles that has been discontinued so they save them for "special cases", tried a couple more spots and succeeded. They never made me feel bad about it, and each one of them hugged me after and apologized for the pain (no Lidocaine was used). They were so kind to me!

However, I just had my pre-op appt for my exchange surgery and the nurse tried to shame me about my precautions. It was horrible, she said a lot of what you heard, like "A foot IV is just a bad idea for so many reasons." I still get mad when I think about it, but I'm standing my ground!

glennie19

Dejaboo:  I'm so sorry you had so many issues with the medical staff,, and it sucks that your LE has gotten worse. UGH!!   (((hugs)))

 

SummerAngel:  and BOOO on that nurse for trying to shame you!  Damn it,, it's not like we WANT a foot IV and extra sticks and extra pain. Don't they get it?  No,, they want what is easiest for them.

Binney4

Dejaboo, I'm so sorry. And SummerAngel, your post reminds us all just how much simple kindness can mean in a difficult situation. It doesn't take any more effort to be empathetic, and the outcome is so much easier on everyone--just can't understand why it doesn't happen more often!

Dejaboo, hoping you'll soon have everything back in control and this whole episode in your rearview mirror.

Gentle hugs,
Binney

Kicks

From all I have 'heard' foot sticks can be painful. If foot stick is needed why not use EMLA/generic cream to make it 'easier'? We use EMLA for port access so why not for other times that are painful?

Dejaboo

SummerAngel- Its terrible when people in the medical field dont take the precautions we need to take -seriously : (

I hope your exchange went good.

Thanks for all the HUGS. My arm is doing better. My Trunk has its good days & its bad days still...but getting there I think.

On a side note...So far I am one that seems to need a Gall Bladder. I can eat unhealthy greasy food just fine...But give me a bowl of cereal in the am...And its not good : (

lisa-e

I had a bmx and had lymph nodes removed on both sides. Getting blood pressure taken with a thigh cuff is always a problem. My onc's office has a thigh cuff but her assistant doesn't know how to use it. I tell them to forget taking my blood pressure because they will not get an accurate reading. When I had my hip replaced after my bmx, I talked my surgeon into a central line. It was lovely because it could be used for blood draws. When I had cataract surgery, they gave me oral sedatives and used my leg for taking bloop pressure. It worked.

It is painful to get a foot IV put in, but it can be easier than getting an IV in the arm. The veins in my foot are better than the ones in my arms. I always wind up with huge bruises after an IV in the arm, but when I have had one in my foot, I don't have any bruising.

carol57

Binney often mentions getting the IV in the neck, which sounds horrid but she says it's really not. Last week I had shoulder arthroscopy on my unaffected side, and it was the anaesthesiologist who brought up the question of where to put the IV and BP cuff, after the prep nurse read my chart and said there were arm precautions noted. So, yay for not having to bring it up myself. Then we had quite a discussion of the possibilities. There was no controversy over putting a BP cuff on my ankle, but the IV question was more problematic. It could not go on my 'good' arm because they wanted nothing on the limb connected to the operative shoulder. I asked about neck, and they deliberated for a moment and then felt that my positioning for the shoulder work would put a neck IV in a challenging location. Same for a foot IV, as apparently my feet would be somehow inaccessible or in a poor position. Perhaps I should have pushed back on that, but in the end I agreed to have the IV on my LE arm. My LE has stabilized at quite mild for nearly a year, with minimal swelling and when I do get that, it's more truncal than arm. I felt that the risk of infection would be absolutely minor, and I asked the nurse to be mindful that pain draws lymph, so she needed to be good and quick with her technique. Which she was.

All's well that ends well, as I had no LE flare from the experience. In fact -- and this was my experience with a prior surgery where my 'good' arm was available for the IV--I actually woke up with and enjoyed for about two days a feeling of 100% absence of any of my usual LE symptoms. No low-level aching and burning; no egg-in-the-armpit feeling; no tingling of the area below my shoulder blade that usually does swell with minor provocation. I suspect this post-surgical relief was from being super-hydrated via the IV before, during, and after surgery.

Next week I'm going to the World Conference of Lymphedema, and there are a couple of sessions where the researchers will discuss the current views and evidence supporting these kinds of precautions. I'll be taking notes! It's a topic that puts us into such an unfortunate tug-of-war with our care givers.

lisa-e

Carol57, I sure hope you post your notes on BCO.

carol57

lisa, I will find a way to post my notes. Probably I will post a link to a document. Getting excited to learn more!

ksusan

Carol, I look forward to your summary!

doxie

Dejaboo,

So sorry you had so much trouble before and after surgery. We are in a very difficult position with the medical staff when in a thin gown, funky blue hair net, dumpy socks, no glasses, no undies and no food in our bellies. Heck even no coffee most times. How more vulnerable can we get?

Carol, Glad your surgery went well. Hope the LE stays in check.

Going on three months to completely heal from trigger thumb surgery. I had inflammation and swelling before and expected some afterwards. My problem was a reaction to the internal stitches. I'm fighting the last tiny bit of infection surrounding them. My thumb is barely swollen, but that could be from arthritis in a different joint. Next surgery I have I'll have to discuss the two problems I've had with these internal stitches. Had a nasty infection around some after a full round of antibiotics following nipple reconstruction on a radiated breast. I blamed those troubles on the damaged radiated tissue. Guess it was more general than that. Took about six months for that LE flare to settle down. With the thumb surgery, I had no LE swelling except what may have been in the thumb. Hard to tease out from what would have been normal with healing from surgery and infection.

SummerAngel

Carol, I'm glad to hear your surgery didn't cause a problem! I'm also interested in hearing more about the latest research in the area. My surgery went well, but I did end up having the same discussion with the nurse and anesthesiologist as I did in my pre-op. They were all nice, which I was grateful for, but went on about how the risk was low and it shouldn't be a problem to use my hand. In the end I told the nurse exactly where the successful IV was during my BMX but she insisted on trying a spot on my other foot first (unsuccessful and now bruised). She went to the spot I indicated for her second try and got it without an issue - there's not even a bruise! I would love to be able to use my hand for IVs and if more evidence comes out that it's ok I would do that, but right now it just doesn't seem known. I had my BP taken on my lower leg and that wasn't something I needed to argue for at all, thankfully. Right before I was discharged the nurse needed one final BP reading and I let her take that on an arm, no issue with it.